Dissertation > Excellent graduate degree dissertation topics show

Feasible Research in Evaluation of Blood Volume with Blood Plasmic Colloid Osmotic Pressure

Author: BaiZeHong
Tutor: XueYuLiang；WangHongWu；ChengWenLi
School: Tianjin Medical University
Course: Anesthesiology
Keywords: Colloid osmotic pressure Assess Blood volume Voluven Ringer
CLC: R614
Type: Master's thesis
Year: 2008
Downloads: 125
Quote: 0
Read: Download Dissertation

Abstract

Plasma colloid osmotic pressure is mainly constituted by a protein molecule, wherein the serum albumin because the smaller molecular weight (about 66000Da), the more the number of molecules (albumin> globulin> fibrinogen), therefore mainly determined by the plasma colloid osmotic pressure factor. According to Starling's law, the plasma colloid osmotic pressure is too low will make the flow of fluid from the intravascular to the interstitial space, resulting in the interstitial tissue (including the heart, brain, lungs and other vital organs) edema, plasma colloid osmotic pressure of the blood volume stability, prevention organization edema play an important role. Albumin significantly reduced, even globulin increase and maintain the plasma protein content is essentially the same, the plasma colloid osmotic pressure will also be significantly reduced. Therefore, the direct determination of plasma colloid osmotic pressure prior to the establishment of the method, the clinical generally projected COP value by detecting the total plasma protein or albumin amount. In this study, colloid osmotic pressure instrument first direct determination of the law and these two formulas projections Comparatively, in order to verify its accuracy. For more major surgery, traumatic hemorrhagic bleeding in critically ill patients, due to the increase in hypovolemic morbidity and mortality significantly related to the rapid and accurate determination of the blood volume is important. . The traditional blood volume measurement methods are as Evans blue called noise cyanide blue-green (ICG) notation, pulse dye density spectrophotometry, isotope-labeled red blood cells or albumin method, carbon monoxide (CO) law, because they are in varying degrees The existence of complex operations, repeatability, and large errors, the application of radioactive substances and other shortcomings, not a method in clinical routine application. So far no effective circulating blood volume quantitative assessment of the clinical means. This paper attempts to apply crystal solution lactated Ringer the colloidal liquid diluted Voluven method determination of blood volume, with the the hemoglobin assay obtained blood volume and blood volume projections in accordance with the height and weight compared to verify the clinical feasibility. Part I: Application of plasma colloid osmotic pressure measurement results purpose of the clinical validation of two formula method: Verify that the the the two formulas reckoning projections accuracy of plasma colloid osmotic pressure. Methods: 40 patients with normal albumin levels anesthesia surgery patients (20 adult patients, 20 cases of children), while 20 patients with low albumin level (chronic end-stage liver disease) anesthesia surgery patients. The application of plasma colloid osmotic pressure meter plasma colloid osmotic pressure measured, both formulas, assess the relevance of the two results. Formula Ⅰ: albumin (g / L) × 0.554 globulin (g / L) × 0.143 = 25 to 27mmHg formula Ⅱ: 2.1 × total proteins (g / dL) 0.16 × total protein ~~ 2 (g / dL) 0.009 × total protein to 3 (g / dL) = colloid osmotic pressure (mmHg). Results: The formula (1) and plasma colloid osmotic pressure instrument assay to be highly correlated, and both statistical results showed no significant difference; formula (2) and plasma colloid osmotic pressure was measured law despite a high degree of correlation, two by statistically significant difference in the results. Conclusion: According to the plasma protein estimation colloid osmotic pressure, the application of the formula (1) and is closer to the actual measurement result. Part II: sodium lactate Ringer solution dilution method congenital heart patients during operative blood volume clinical research purposes: verify lactated Ringer solution dilution method for the determination of the feasibility of perioperative blood volume of patients with congenital heart disease. Methods: 20 cases of general anesthesia patients (CHD), intravenous infusion of a certain amount of sodium lactate Ringer's solution as the diluted indicator determination infusion plasma colloid osmotic pressure changes, according to formula (1): BV = P2 × C / [(P1 -P2) (P2-P1) × Hct] calculated blood volume, calculated blood volume infusion before and after the changes in hemoglobin concentration, the two methods calculated blood volume numerical estimates of height and weight compared with the preoperative assessment of its sex. Results: the value obtained with the hemoglobin resulting value of the colloid osmotic pressure method has a high degree of correlation (r = 0.9912), and both measurement results was no significant difference (p> 0.05); colloid osmotic pressure method value obtained by preoperative height and weight estimates Compared although the correlation (r = 0.9756), but its absolute value of the two methods result in a difference (p <0.05). Conclusion: Sodium Lactate Ringer's solution enter the body, at least in the early remains short-term expansion of the role played in the intravascular; sodium lactate Ringer's solution diluted some feasibility determination of colloid osmotic pressure changes in the assessment of blood volume. Part III: Voluven dilution method congenital heart patients during operative blood volume clinical research purposes: to verify the application Voluven dilution method congenital heart patients during the feasibility of operative blood volume. Methods: 20 cases of congenital heart disease patients undergoing elective surgery, intravenous certain amount Wan Timor as a dilution indicator plasma colloid osmotic pressure, the Ibid calculated estimation of blood volume, and at the same time the proportion of in vitro dilution to exclude the body The impact of the process on the test results. The same changes in hemoglobin concentration determination of blood volume, blood volume values ??were calculated dilution method both in vivo and in vitro Voluven hemoglobin dilution calculated by height and weight estimates and preoperative compared to assess the correlation. Results: In vitro the dilution method Voluven obtained value hemoglobin value obtained were highly correlated (r = 0.9900), and both the absolute value of measurement results was no significant difference (p> 0.05).; The body Voluven dilution method the value obtained with hemoglobin dilution method and by height and weight estimates compared although the correlation, but the determination of the value of the two results significant difference (p <0.01). Conclusion: Voluven enter the body early expansion of the role of more than 100%; the in vitro Voluven dilution method is feasible to assess blood volume.

Feasible Research in Evaluation of Blood Volume with Blood Plasmic Colloid Osmotic Pressure

Abstract

Related Dissertations