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ObjectiveTo establish a mathematical formula for choosing the manner of replacement fluid infusion in continuous renal replacement therapy (CRRT), so as to provide the basis for improving the treatment effect. Methods A mathematical formula for choosing the manner of replacement fluid infusion with continuous veno-venous hemofiltration (CVVH) was taken as an example, and it was compared with the result of standard replacement fluid in order to analyze the effect of different manners of infusion.① Comparison parameters: the plasma volume (Vreturn) and some electrolyte concentration (Creturn) in back way of CRRT (if other thing was solute, filter coefficient should be 1.0).② Research objects: the actual replacement fluid (for example, the most complex should be sorted into A and B type) mode (pre or post) was compared with the standard replacement fluid (the A and B in one).③ Based on the formula of standard replacement, four equations in different conditions were derived: pre-dilution and post-dilution mode; same direction and same ratio; same direction and different ratio; different direction and same ratio; different direction and different ratio.Results The calculated results of Vreturn (except hematocrit) and Creturn were same to the standard only following the rule of same direction and ratio for A and B no matter pre-dilution mode or post-dilution mode, and it was different from the standard in others. In pre-dilution mode and post-dilution mode, it showed:① A and B in same direction and different ratio: Vreturn and Creturn were different from the standard for the alterative ratio of B.② A and B in different direction and same ratio: Vreturn was same to the standard, but Creturn was different from the standard for the completely different and more complex computational formula.③ A and B in different direction and different ratio: both Vreturn and Creturn were different from the standard. The different Vreturn was due to the different ratio of B. The different Creturn was caused by different ratio of B and the completely different computational formula.Conclusions① For parts of replacement fluid which must be separated ( for example, bicarbonate formula ), the result is same to the standard, and is predicted and mastered only following the rule of same direction and ratio. Otherwise, we need to calculate the two parameters over and over again. The result will run out of our judgment. The wrongness of losing water and electrolyte disorders maybe come out.② Accordingly,the formula could be used to analyze the same case like the separated replacement infusion, for example, a large number of citrates as regional anticoagulation were infused only in the front of filter, while the replacement fluid can be done in varied forms.
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Objective To compare the clinical curative effect of virus inactivating activity of plasma and albumin compound sodium chloride injection in liquid plasma exchange(PE)for treatment of severe systemic lupus erythematosus(SLE).Methods A total of 75 cases of severe SLE patients were randomized according to the number table method patients for virus inactivation of plasma group A(37 cases)and liquid albumin plasma group B (38 cases). The changes of immunoglobulin protein(IgG,IgA,IgM),ESR,complement C3,C -reactive protein(CRP),blood urea nitrogen(BUN)and serum creatinine(CR)index in the two groups were observed before and after PE.Clinical SLE-DAI(systemic lupus erythematosus disease activity index)score changes,adverse reactions occurred rate and clinical efficacy of two groups were compared.Results After treatment of group A was treated with PE,laboratory indicators except IgM(t =0.509,P =0.612),other indexes were significantly decreased,differences were statistically significant (t =29.447,186,56.447,41.867,12.841,92.675,92.980,all P 0.05),while IgG and ESR,bun,crea and replacement of the differences have statistical significance(t value were 28.999,194.9,40.634,40.634104.918, P value 0.05).Conclusion The clinical curative effect of virus inactivation of plasma replacement solution in treatment of severe SLE is better than that of albumin by Ringer's solution.
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BACKGROUND: Therapeutic plasma exchange (TPE) is an effective and practical treatment for separation and removal of harmful antibodies or pathogenic substances from the blood. The volume of plasma removed must be replaced by a replacement fluid such as 4~5% albumin solution or Fresh frozen plasma (FFP). We conducted a study of coagulopathy using albumin solution and checked the chemical composition of fresh frozen plasma. METHODS: We measured pre- and post-TPE PT/aPTT for evaluation of the effect of albumin replacement on coagulation from 192 TPE sessions of 19 patients. We also investigated routine chemistry test items including glucose and electrolytes from 10 randomly selected FFP. RESULTS: The post PT and aPTT within four hours after TPE were prolonged due to a transient decrease in coagulation factors, but were normalized within 2 days after TPE. All coagulation time was corrected to the level of the pre-TPE status within four hours before the next TPE except the patients who received TPE 6 times or more. FFP showed higher level in glucose, sodium and inorganic phosphate. CONCLUSION: Albumin exchange produces temporary coagulation factor deficiency. However, this transient factor deficiency rarely causes clinical problems and the factors are rapidly corrected by redistribution and resynthesis. We should be careful about hypocalcemia, hyperglycemia, and hypernatremia when using FFP replacement.
Subject(s)
Humans , Antibodies , Blood Coagulation Factors , Chemistry , Electrolytes , Glucose , Hyperglycemia , Hypernatremia , Hypocalcemia , Plasma , Plasma Exchange , SodiumABSTRACT
Objective To prove with mathematical formula that the patient's blood electrolyte concentration shows a tendency to approach that of replacement-fluid after continuous renal replacement therapy (CRRT).Methods Electrolyte concentration of plasma,replacement-fluid and returning fluid were compared,and they were labeled as Cblood,Cnom,and Creturn respectively.The Creturn was calculated,and the relationship among them was demonstrated with comparison by mathematical formula.At last,according to their relationship,plasma change towards to the replacement fluid was analyzed.Results It was showed that Cblood＜Creturn＜Cnom or Cblood＞Creturn＞ Cnom,and according the relationship,it was derive that the trend of change in Cblood after circulation for m unit time was Cblood1 ＞Cblood2 ＞Cblood3 ＞ … ＞Cbloodm ＞Cblood or Cblood1 ＜ Cblood2 ＜Cblood3 ＜ … ＜Cbloodm ＜Cnom.The plasma electrolyte concentration would close to that of replacement fluid infinitely with the continue of CRRT.Conclusions With mathematical model,it is proved that the replacement fluid electrolyte concentration is the final target of the plasma.We must make up the replacement fluid correctly.And this results provide the basis for CRRT treatment of electrolyte disorder.
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Objective To compare the clinical efficacy of three kinds of replacement fluid for continuous hemofiltration in severe sepsis,and to develop a more rational composition.Methods Fifty severe sepsis patients with continuous hemofiltration were divided into four groups randomly.The configuration of the replacement fluid in accordance with the random number table,randomly selected from four different formulations:group A (13 cases):Ports composition provided by Nanjing general hospital;group B (12 cases):Zhongshan hospital composition; group C (11 cases):an improved composition; group D (14 cases):an improved composition by Donghua hospital affiliated to SUN Yat-sen university.Blood electrolytes,blood gas analysis,renal function,blood glucose(highest and lowest serum glucose in treatment period),high sensitive C-reactive protein(hs-CRP) concentration,calcium concentration in filter were tested before and after every treatment period.Results The concentration of blood electrolytes during treatment had no significant change (P ＞ 0.05).Renal function were improved significantly after treatment among four groups (P ＜ 0.05).The level of hs-CRP decreased significantly after treatment (P ＜ 0.05) and there was no significant difference among four groups (P ＞ 0.05).The change of serum glucose during treatment was the smallest in group D than that in group A,B,C [(3.0 + 0.9) mmol/L vs.(11.2 + 2.0),(3.8 + 1.1),(5.5 +1.3) mmol/L](P ＜ 0.05).Calcium concentration in filter was the lowest in group D than that in group A,B,C [(1.5 + 0.5) mmol/L vs.(2.0 + 0.7),(2.3 + 0.5),(2.1 + 0.4) mmol/L] (P ＜ 0.05).The dosage of heparin was the least during treatment in group D than that in group A,B,C[(6.5 ± 2.8) U/(kg·h) vs.(8.9 ± 3.4),(7.9 ± 3.0),(8.7 ± 3.1) U/ (kg· h)] (P ＜ 0.05).Conclusions Improved composition by Donghua hospital affiliated to SUN Yat-sen university hospital compared to other compositions can better maintain a stable blood glucose levels,have a better anticoagulant effect,reducing the application of heparin,maintain a stable homeostasis.It is worthy of using in clinic.
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BACKGROUND: We investigated the effect that replacement with Ringer's lactate (RL) for preoperative NPO deficits might have on blood glucose concentration in children undergoing strabismus surgery. METHODS: Sixty children scheduled for strabismus surgery were enrolled in this study and RL was administered to all subjects for replacement of preoperative NPO deficits.Patients were randomly assigned to three groups according to the types of maintenance fluid employed during anesthesia.RL, 5% dextrose in one-fourth strength normal saline (D51/4NS), and an equal volume of D(5)1/4NS and RL each were used as maintenance fluids for Group 1, 2, and 3, respectively.After glycopyrrolate 0.004 mg/kg IV, anesthesia was induced with propofol 3 mg/kg and rocuronium 0.6 mg/kg.After tracheal intubation, anesthesia was maintained with 2-3 vol% sevoflurane in 50% air with oxygen.Blood glucose concentrations were checked from blood samples through a 22 gauge catheter inserted into a saphenous vein at the time of induction, 30 and 60 min after induction of anesthesia. RESULTS: There were no significant differences in baseline blood glucose levels at the time of induction of anesthesia among three groups.And the mean blood glucose concentrations remained unchanged throughout the study period in all groups.None of the patients were found to be hypoglycemic or hyperglycemic throughout the study period. CONCLUSIONS: This study shows that the replacement of preoperative NPO deficits with RL maintains the blood glucose concentration within physiological range throughout the operation and anesthetic recovery phase, regardless of the types of maintenance fluid.
Subject(s)
Child , Humans , Androstanols , Anesthesia , Blood Glucose , Catheters , Glucose , Glycopyrrolate , Hyperglycemia , Hypoglycemia , Intubation , Isotonic Solutions , Lactic Acid , Methyl Ethers , Propofol , Saphenous Vein , StrabismusABSTRACT
To determine the ocular toxicity of intravitreal miconazole, we conducted a controlled trial in 20 pigmented rabbit eyes(10 rabbits). An anterior chamber paracentesis was performed on all animals and 0.4 ml of perfluoropropane(C3F8) gas was injected intravitreally. On day three, when it was fully expanded, eyes were underwent C3F8/fluid exchange with vitreous replacement fluid. The infusion solution contained various amounts of miconazole, 0.5 microgram/ml. 1 microgram/ml, 5 microgram/ml, 10 microgram/ml, 50 microgram/ml, 100 microgram/ml and normal saline for control. Intravitreal infusion was performed for 25-30 minuteds and a total of 100-120 ml of fluid was replaced. Histopathological examination revealed retinal toxic reactions in concentrations of 10 microgram/ml or greater. This study suggests that infusion solution of 5 microgram/ml or less is the concentration exceeds the minimal inhibitory concentration for most of fungi and may be safetly used in the treatment of fungal endaphthalmitis.