Infusionstherapie (Basel, Switzerland)
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparative study of the intraoperative effectiveness of 5% human albumin or 10% hydroxyethyl starch (HAES-steril) on hemodynamics and oxygen transport in 40 patients].
In 40 patients, whose expected hemodynamic instability during surgery necessitated invasive monitoring (Swan-Ganz catheter) and arterial pressure monitoring the hemodynamic and oxygen transport parameters in conditions of hypervolemic hemodilution were investigated in randomized tests. After insertion of an arterial catheter (arteria radialis) as well as Swan-Ganz pulmonary arterial catheter via the vena jugularis interna, one of the two volume substitutes selected at random was infused in quantities of 125 ml/5 min and the hemodynamic changes were measured after infusion of 500 ml and finally after a wedge pressure of 18 mmHg was reached. Using either solution, the measurements indicated significant increases in mean arterial pressure as well as in central venous pressure (ZVD) and wedge pressure. ⋯ In the case of both volume substitutes, there was an improvement in oxygen availability. The hemoglobin content decreased in both groups, though to different degrees in each group. Although the hydroxyethyl starch group registered a greater improvement in the cardiac index, a bigger decrease in pulmonary vascular resistance, a higher rise in the left ventricular stroke work index and a more significant improvement in stroke output, smaller quantities of the volume substitute were required in this group than in the group in which volume substitution was carried out with human albumin 5%.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
[Effect of a 10% and 6% hydroxyethyl starch solution (molecular weight 200,000/0.62) in comparison with a 10% dextran solution (molecular weight 40,000) on flow properties of blood and tissue oxygen pressure in patients with intermittent claudication].
In a randomized, double-blind cross-over study in 10 patients with intermittent claudication, 2 concentrations (6% and 10%) of a hydroxyethyl starch (HES) solution of mean molecular weight 200,000 and of substitution degree 0.62 were compared to a 10% low-molecular-weight dextran solution of mean molecular weight 400,000. In addition to several hemorheological parameters, the behavior of the tissue oxygen pressure directly in the ischemic lower leg muscles of patients with chronic arterial occlusive vascular disease (stage IIb) was examined. 500 ml of the solutions described above were infused over a period of 30 min. Parameters such as tissue oxygen pressure and flow properties of blood were determined before infusion, immediately upon terminating infusion and 30, 60, 90, 120 and 180 min thereafter. ⋯ This behavior was less pronounced with the 6% solution. Measurement of the erythrocyte aggregation yielded an increase in values after infusion which was more significant for the 10% than for the 6% HES solution. The tissue oxygen pressure, as a measure of the tissue oxygen supply, remained more or less constant during hypervolemic hemodilution, despite reduced hematocrit values in the dextran group and in the 10% HES group.(ABSTRACT TRUNCATED AT 250 WORDS)