Krystaloidy a koloidy jsou běžně používané jak perioperačně, tak v intenzivní medicíně. V současnosti je hodně diskutované téma, jaký typ roztoků by měl být preferován s ohledem na jejich negativní účinek na koagulaci. Následující článek shrnuje dosavadní poznatky o vlivu infuzních roztoků na krevní srážlivost měřenou pomocí standardních laboratorních testů PT a APTT, ale i metodou tromboelastografie a metodou rotační tromboelastometrie. Cílem je dle dostupných dat určit infuzní roztok, který nejméně ovlivňuje krevní srážlivost.
Crystalloids and colloids are ubiquitous in perioperative and intensive care medicine. However, there is still a vivid debate about which solution has the minimal negative effect on coagulation. The following article summarizes the existing knowledge about the influence of infusion solutions on blood coagulation measured by standard coagulation tests such as PT and APTT, and also using tromboelasthography and rotational thromboelastometry. The goal was to determine which infusion solution has the least negative effect on blood coagulation in the published literature.
- MeSH
- Hemodilution MeSH
- Blood Coagulation * drug effects MeSH
- Isotonic Solutions * classification therapeutic use MeSH
- Colloids pharmacology therapeutic use MeSH
- Crystalloid Solutions pharmacology therapeutic use MeSH
- Humans MeSH
- Serum Albumin, Human therapeutic use MeSH
- Fluid Therapy MeSH
- Thrombelastography methods MeSH
- Gelatin therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Recently, we have established a model of severe stepwise normovolemic hemodilution to a hematocrit of 10 % in rats employing three different colloidal volume replacement solutions (Voluven, Volulyte and Gelafundin) that are routinely used in clinical practice at present. We did not see severe dilutional acidosis as to be expected, but a decline in urinary pH. We here looked on further mechanisms of renal acid excretion during normovolemic hemodilution. Bicarbonate, which had been removed during normovolemic hemodilution, was calculated with the help of the Henderson-Hasselbalch equation. The urinary amount of ammonium as well as phosphate was determined in residual probes. The absolute amount of free protons in urine was obtained from the pH of the respective samples. The amount of protons generated during normovolemic hemodilution was approximately 0.6 mmol. During experimental time (5.5 h), distinct urinary ammonium excretion occurred (Voluven 0.52 mmol, Volulyte 0.39 mmol and Gelafundin 0.77 mmol). Proton excretion via the phosphate buffer constituted 0.04 mmol in every experimental group. Excretion of free protons was in the range of 10(-6) mmol. The present data prove that the prompt rise in urinary ammonium excretion is also valid for acute metabolic acidosis originating from severe normovolemic hemodilution.
- MeSH
- Acidosis physiopathology urine MeSH
- Ammonium Compounds urine MeSH
- Hemodilution adverse effects methods MeSH
- Rats MeSH
- Models, Animal * MeSH
- Rats, Wistar MeSH
- Severity of Illness Index * MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Postupy bezkrevní medicíny používané v předoperační přípravě, chirurgickém a anesteziologickém managementu a v pooperační péči snižují velikost krevní ztráty. Pokles počtu podaných transfuzí může vést ke snížení pooperační mortality i morbidity.
The methods of bloodless medicine used in preoperative treatment, surgical and anaesthesiological management and postoperative care reduce the amount of blood loss. Decrease in the number of blood transfusions can lead to a decrease in postoperative mortality and morbidity.
- Keywords
- cell-saver,
- MeSH
- Anemia drug therapy therapy MeSH
- Anesthesiology MeSH
- Bloodless Medical and Surgical Procedures * methods MeSH
- Hemodilution MeSH
- Hemostatic Techniques MeSH
- Hemostatics therapeutic use MeSH
- Hemostasis, Surgical methods MeSH
- Hypotension, Controlled MeSH
- Blood Transfusion trends MeSH
- Hemorrhage surgery therapy MeSH
- Humans MeSH
- Perioperative Care * methods MeSH
- Postoperative Hemorrhage prevention & control MeSH
- Preoperative Care MeSH
- Surgical Clearance MeSH
- Embolization, Therapeutic MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Blood Transfusion, Autologous * statistics & numerical data MeSH
- Cytapheresis statistics & numerical data MeSH
- Hemodilution statistics & numerical data MeSH
- Blood microbiology MeSH
- Humans MeSH
- Plasmapheresis statistics & numerical data MeSH
- Preoperative Care * MeSH
- Surveys and Questionnaires MeSH
- Blood Component Removal statistics & numerical data MeSH
- Statistics as Topic MeSH
- Health Facilities MeSH
- Check Tag
- Humans MeSH
- Publication type
- Statistics MeSH
- News MeSH
- Geographicals
- Czech Republic MeSH
Soudobá medicína se neustále rozvíjí v oblasti kvality požadované zvyšujícími se nároky klientů na rychlé, efektivní a kvalitní řešení jejich zdravotních problémů. Moderní operační techniky se zdokonalují a s nimi i způsob hrazení krevních ztrát předoperačně, peroperačně, a především pooperačně. Postupně se odkláníme od převodů alogenní transfuze krve a přistupuje se stále častěji k hrazení krevních ztrát pomocí pooperačních netransfuzních systémů.
- MeSH
- Blood Transfusion, Autologous utilization MeSH
- Hemodilution MeSH
- Hemoglobinometry instrumentation MeSH
- Humans MeSH
- Arthroplasty, Replacement, Hip MeSH
- Orthopedic Procedures * methods MeSH
- Operative Blood Salvage * MeSH
- Patient Care Planning MeSH
- Postoperative Complications surgery prevention & control MeSH
- Prostheses and Implants classification MeSH
- Jehovah's Witnesses MeSH
- Check Tag
- Humans MeSH
Damage control surgery j e soubor život zachraňujících, etapových úkonů k ošetření závažných nitrobřišních poranění. Cílem časného ošetření je omezení vlivu „smrtelné“ triády- acidózy, hypotermie, hypokoagulace. Definitivní ošetření poranění tkání je v tomto konceptu odsunuto až na okamžik hemodynamické a hemokoagulační stability poraněného.
Damage control surgery is a complex of life-saving, multiple-phase procedures for treating serious internal abdominal injuries. The goal of timely treatment is to limit the influence of the „trauma triad of death“- hypothermia, acidosis and coagulopathy. The definitive treatment of the injured tissues is, as per this concept, postponed until the patient is stable in terms of haemodynamics and haemocoagulation.
- MeSH
- Acidosis complications MeSH
- Time Factors MeSH
- Gastrointestinal Hemorrhage * etiology surgery MeSH
- Hemodilution adverse effects MeSH
- Hypothermia complications MeSH
- Blood Coagulation Disorders * etiology complications mortality prevention & control therapy MeSH
- Blood Transfusion methods MeSH
- Laparotomy methods MeSH
- Humans MeSH
- Partial Thromboplastin Time methods standards MeSH
- Abdominal Injuries * surgery complications MeSH
- Transfusion Reaction MeSH
- Prothrombin Time methods standards MeSH
- Check Tag
- Humans MeSH
Účel studie: Cílem této pilotní studie bylo popsat změny v lipidovém metabolizmu u pacientů s akutním krvácením do gastrointestinálního traktu (GIT) a posoudit možný vliv hemodiluce a změn v procesu získávání cholesterolu (syntéza a absorpce). Materiál a metody: U dvanácti pacientů s akutním krvácením do GIT byly stanoveny hodnoty lipidového metabolizmu (celkový, LDL a HDL cholesterol, triglyceridy) v den 0, 3 a 6. Ve stejných termínech byly stanoveny hladiny ukazatelů cholesterolové syntézy (skvalen, lathosterol) a absorpce (sitosterol, kampesterol). Výsledky byly hodnoceny srovnáním s kontrolním souborem a porovnáním nemocných s cirhózou a bez postižení jater. Současně byl hodnocen vztah mezi lipidy a hodnotami hemoglobinu, hematokritu a spotřebou transfuzí. Výsledky: Hladiny celkového cholesterolu byly sníženy významně (p < 0,001), HDL a LDL nevýznamně a triglyceridy byly v normě. Hladiny lathosterolu byly sníženy signifikantně (p < 0,05), skvalenu, kampesterolu a sitosterolu nesignifikantně. Porovnání pacientů s cirhózou a bez ní přineslo statisticky významný rozdíl v hladinách cholesterolu a lathosterolu (p < 0,05). Korelace nepřinesly statisticky významné nálezy. Závěr: U pacientů s akutním krvácením do horního GITu byly prokázány změny v metabolizmu lipidů včetně alterace procesu syntézy i absorpce. Hypocholesterolemii proto nelze vysvětlit pouze krevní ztrátou. Je nutné provést další podrobnější studie.
Purpose of the study: The aim of this pilot study was to describe changes in lipid metabolism in patients with acute gastrointestinal (GI) bleeding and to assess possible influence of hemodilution and changes in the cholesterol synthesis/absorption process. Material and methods: In 12 patients with gastrointestinal bleeding, the levels of lipid metabolism (total, LDL and HDL cholesterol and triglycerides) were determined on days 0, 3 and 6. On the same days, levels of the cholesterol synthesis indexes (lathosterol, squalene) and absorption (campesterol, sitosterol) were determined. The results were evaluated in comparison with the control set, and cirrhotic and non-cirrhotic patients were compared. At the same time, correlations of lipids and haemoglobin, hematocrit levels anduse of transfusions were evaluated. Results: The patients had significantly lower levels of total cholesterol (p < 0.001). Decrease of LDL and HDL cholesterol was not significant. Concentrations of triglycerides were normal. Decrease of lathosterol was significant (p < 0.05), but decrease in squalene, campesterol and sitosterol levels was insignificant. Comparing patients with cirrhosis and without cirrhosis showed statistically significant difference in levels of cholesterol and lathosterol (p < 0.05). Correlations did not show any statistically significant findings. Conclusion: In patients with acute GI bleeding, changes is lipid metabolism including alteration of the process of synthesis and absorption were proved. Therefore, hypocholesterolemia cannot be explained by blood loss only. However, more detailed studies need to be carried out. 30. 1. 2013
- MeSH
- Acute Disease MeSH
- Time Factors MeSH
- Cholesterol * analogs & derivatives blood metabolism MeSH
- Phytosterols blood MeSH
- Gastrointestinal Hemorrhage * blood metabolism MeSH
- Cholesterol, HDL blood metabolism MeSH
- Hematocrit MeSH
- Hemodilution MeSH
- Liver Cirrhosis complications MeSH
- Critical Illness MeSH
- Cholesterol, LDL blood metabolism MeSH
- Middle Aged MeSH
- Humans MeSH
- Lipids MeSH
- Pilot Projects MeSH
- Sitosterols blood MeSH
- Squalene blood MeSH
- Statistics as Topic MeSH
- Sterols MeSH
- Case-Control Studies MeSH
- Triglycerides blood metabolism MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
Hypocholesterolemia is commonly found in critically ill patients; however, the aetiology of this condition remains unclear. Several clinical studies refer to the possible negative impact of haemodilution on cholesterol (CH) metabolism in acute medical conditions. The aim of this study was to examine the serum CH profile (total CH, LDL and HDL CH) during acute gastrointestinal bleeding which is a life-threatening condition characterised by alterations in lipid metabolism. Serum non-CH sterols (lathosterol, squalene, sitosterol and campesterol) concentrations as markers of CH synthesis and CH absorption were measured at the same time. Twenty-four patients with acute upper gastrointestinal bleeding (UGIB) were measured for these parameters over a 6-day period. The control group was 100 healthy blood donors.We found lower plasma levels of total CH (p < 0.001) and LDL CH (p < 0.05) in patients with UGIB than in the control group. The decreased HDL CH plasma levels in patients were not statistically significant. In addition, patients had significantly lower plasma levels of lathosterol, squalene, campesterol and sitosterol (p < 0.05).Our results showed abnormalities not only in the CH plasma profile, but also in plasma concentrations of non-CH sterols. These findings of alterations in both the CH synthesis and absorption process could be a contributory cause of hypocholesterolemia during acute gastrointestinal bleeding. However, further research is necessary.
- MeSH
- Acute Disease MeSH
- Cholesterol blood MeSH
- Esophageal and Gastric Varices blood etiology therapy MeSH
- Endoscopy, Gastrointestinal MeSH
- Gastrointestinal Hemorrhage blood etiology therapy MeSH
- Cholesterol, HDL blood MeSH
- Hematemesis blood therapy MeSH
- Hemodilution adverse effects MeSH
- Hypercholesterolemia blood MeSH
- Proton Pump Inhibitors administration & dosage MeSH
- Infusions, Intravenous MeSH
- Liver Cirrhosis blood complications therapy MeSH
- Intensive Care Units MeSH
- Cohort Studies MeSH
- Combined Modality Therapy MeSH
- Cholesterol, LDL blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Lypressin administration & dosage analogs & derivatives MeSH
- Melena blood therapy MeSH
- Follow-Up Studies MeSH
- Omeprazole administration & dosage MeSH
- Parenteral Nutrition, Total MeSH
- Aged MeSH
- Fluid Therapy MeSH
- Erythrocyte Transfusion MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Blood Transfusion, Autologous * methods statistics & numerical data MeSH
- Cytapheresis statistics & numerical data MeSH
- Hemodilution statistics & numerical data MeSH
- Plasmapheresis statistics & numerical data MeSH
- Preoperative Care MeSH
- Surveys and Questionnaires MeSH
- Health Facilities * MeSH
- Publication type
- Statistics MeSH
- Tables MeSH
- Geographicals
- Czech Republic MeSH
