中分子右旋糖酐扩容治疗烧伤休克临床研究之二──中分子右旋糖酐输入过量对水肿回收期的影响

Clinical Research on Medium Molecular Weight Dextran for Blood Volume Expansion in Treating Burn Shock Ⅱ──The Effect of Excessive Infusion of Medium Molecular Weight Dextran on the Recovery of Edema

多数资料已证实，输入大量中分子右旋糖酐（中右）可干扰血型的鉴定、凝血机制、出血时间延长并产生出血倾向、内皮系统功能，或致肾功不全等。但对烧伤休克期输入过多中右影响水肿回收期的情况，尚未见报道。本文对1981～1989年特重烧伤142例，其中92例接受中右扩容。重点对其中83例进行分析。一组为合理用量组1500ml以内，另一组为超量组1500ml以上，发现超量组水肿回收明显延长。作者对其延长原因进行了分析，一是中右虽分子量平均为70000，但大小不等，大分子溢出血管后回收困难，二是中右结合水分较白蛋白为高，如此而致水肿回收期延长。

It has been proved that excessive infusion ofmedium molecular weight dextran may interfere withblood grouping test , blood coagulation mechanismand endothelial system function. prolong bleedingtime and increase the tendency of bleeding or result inrenal insufficiency. The effect of excessive infusion ofmedium molecular weight dextran on the recovery ofedema is not yet very clear. This paper reports 92cases of exceptionally severe burn treated withinfusion of medium molecular weight dextran. Patientsin the first group were infused with no more than 1, 500ml of the dextran and those in the second group morethan 1, 500ml. The time for the recovery of edemawas remarkably prolonged in the group of patientsreceiving excessive infusion of the dextran. Theauthors analyzed the causes of the prolongation of therecovery of edema and concluded that 1. the dextranwith an average molecular weight of 70, 000 varieslargely in molecular weight of individual molecules.Dextran with larger molecular weight is difficult to beabsorbed when coming out of the vessel and 2. thedextran binds more strongly with water than with protein.