Using transesophageal echo-Doppler, it is demonstrated that preoperative acute hypervolemic hemodilution(HHD) with 6% hydroxyethel starch(HES) significantly increased in intravascular volume, DO2, CO, SV and CI, marke...Using transesophageal echo-Doppler, it is demonstrated that preoperative acute hypervolemic hemodilution(HHD) with 6% hydroxyethel starch(HES) significantly increased in intravascular volume, DO2, CO, SV and CI, markedly decreased in SVR and remained stable in MAP and HR, which indicates HES infused at 20 ml*kg-1 is safe in patient without cardiac disease.展开更多
Objective： Hemodilution changes the physical properties of blood by reducing its hematocrit and blood viscosity. We tested whether prolonged hypervolemic hemodilution （HHD） impairs functional capillary density （FC...Objective： Hemodilution changes the physical properties of blood by reducing its hematocrit and blood viscosity. We tested whether prolonged hypervolemic hemodilution （HHD） impairs functional capillary density （FCD） of ileal mucosa in healthy mechanically-ventilated pigs and if there is any correlation between changes in FCD of ileal and sublingual mucosas during HHD. Methods： Sixteen domestic female pigs were anesthetized, mechanically-ventilated, and randomly assigned to the HHD （20 ml/（kg.h） Hartmann＇s solution for 3 h） or fluid restrictive （5 ml/（kg-h） Hartmann＇s solution for 3 h） group. Microcirculations of sublingual and ileal mucosas via ileostomy were visualized using sidestream dark-field （SDF） imaging at baseline conditions （t=0 h） and at selected time intervals of fluid therapy （t=-l, 2, and 3 h）. Results： A significant decrease of ileal FCD （285 （278-292） cm/cm^2） in the HHD group was observed after the third hour of HHD when compared to the baseline （360 （350-370） cm/cm2） （P〈0.01）. This trend was not observed in the restrictive group, where the ileal mucosa FCD was significantly higher after the third hour of fluid therapy as compared to the HHD group （P〈0.01）. No correlation between microhemodynamic parameters obtained from sublingual and ileal mucosas was found throughout the study. Conclusions： Prolonged HHD established by crystalloid solution significantly decreased ileal villus FCD when compared to restrictive fluid regimen. An inappropriate degree of HHD can be harmful during uncomplicated abdominal surgery.展开更多
An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis.Natremia imbalance and,in particular,hyponatremia is the most frequent electrolyte abnormality...An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis.Natremia imbalance and,in particular,hyponatremia is the most frequent electrolyte abnormality observed in hospitalized subjects,involving approximately one-fourth of them.Pathological changes occurring during liver cirrhosis predispose patients to an increased risk of sodium imbalance,and hypervolemic hyponatremia has been reported in nearly 50%of subjects with severe liver disease and ascites.Splanchnic vasodilatation,portal-systemic collaterals’opening and increased excretion of vasoactive modulators are all factors impairing clear water handling during liver cirrhosis.Of concern,sodium imbalance has been consistently reported to be associated with increased risk of complications and reduced survival in liver disease patients.In the last decades clinical interest in sodium levels has been also extended in the field of liver transplantation.Evidence that[Na+]in blood is an independent risk factor for in-list mortality led to the incorporation of sodium value in prognostic scores employed for transplant priority,such as model for end-stage liver disease-Na and UKELD.On the other hand,severe hyponatremic cirrhotic patients are frequently delisted by transplant centers due to the elevated risk of mortality after grafting.In this review,we describe in detail the relationship between sodium imbalance and liver cirrhosis,focusing on its impact on peritransplant phases.The possible therapeutic approaches,in order to improve transplant outcome,are also discussed.展开更多
文摘Using transesophageal echo-Doppler, it is demonstrated that preoperative acute hypervolemic hemodilution(HHD) with 6% hydroxyethel starch(HES) significantly increased in intravascular volume, DO2, CO, SV and CI, markedly decreased in SVR and remained stable in MAP and HR, which indicates HES infused at 20 ml*kg-1 is safe in patient without cardiac disease.
基金Project (No. MZO 00179906) supported by the Ministry of Health,Czech Republic
文摘Objective： Hemodilution changes the physical properties of blood by reducing its hematocrit and blood viscosity. We tested whether prolonged hypervolemic hemodilution （HHD） impairs functional capillary density （FCD） of ileal mucosa in healthy mechanically-ventilated pigs and if there is any correlation between changes in FCD of ileal and sublingual mucosas during HHD. Methods： Sixteen domestic female pigs were anesthetized, mechanically-ventilated, and randomly assigned to the HHD （20 ml/（kg.h） Hartmann＇s solution for 3 h） or fluid restrictive （5 ml/（kg-h） Hartmann＇s solution for 3 h） group. Microcirculations of sublingual and ileal mucosas via ileostomy were visualized using sidestream dark-field （SDF） imaging at baseline conditions （t=0 h） and at selected time intervals of fluid therapy （t=-l, 2, and 3 h）. Results： A significant decrease of ileal FCD （285 （278-292） cm/cm^2） in the HHD group was observed after the third hour of HHD when compared to the baseline （360 （350-370） cm/cm2） （P〈0.01）. This trend was not observed in the restrictive group, where the ileal mucosa FCD was significantly higher after the third hour of fluid therapy as compared to the HHD group （P〈0.01）. No correlation between microhemodynamic parameters obtained from sublingual and ileal mucosas was found throughout the study. Conclusions： Prolonged HHD established by crystalloid solution significantly decreased ileal villus FCD when compared to restrictive fluid regimen. An inappropriate degree of HHD can be harmful during uncomplicated abdominal surgery.
文摘An adequate balance between electrolytes and clear water is of paramount importance to maintaining physiologic homeostasis.Natremia imbalance and,in particular,hyponatremia is the most frequent electrolyte abnormality observed in hospitalized subjects,involving approximately one-fourth of them.Pathological changes occurring during liver cirrhosis predispose patients to an increased risk of sodium imbalance,and hypervolemic hyponatremia has been reported in nearly 50%of subjects with severe liver disease and ascites.Splanchnic vasodilatation,portal-systemic collaterals’opening and increased excretion of vasoactive modulators are all factors impairing clear water handling during liver cirrhosis.Of concern,sodium imbalance has been consistently reported to be associated with increased risk of complications and reduced survival in liver disease patients.In the last decades clinical interest in sodium levels has been also extended in the field of liver transplantation.Evidence that[Na+]in blood is an independent risk factor for in-list mortality led to the incorporation of sodium value in prognostic scores employed for transplant priority,such as model for end-stage liver disease-Na and UKELD.On the other hand,severe hyponatremic cirrhotic patients are frequently delisted by transplant centers due to the elevated risk of mortality after grafting.In this review,we describe in detail the relationship between sodium imbalance and liver cirrhosis,focusing on its impact on peritransplant phases.The possible therapeutic approaches,in order to improve transplant outcome,are also discussed.
