20xx年醫(yī)學(xué)專題—毛細(xì)血管滲漏綜合征診治策略-預(yù)覽頁
【正文】 ：12521258． Tian J．Hydroxyethyl starch and capillary leak syndrome[J]．AnesthAnalg．2004．98(3)：768774．,第二十四頁，共四十六頁。 li,11/11/2024,25,Resuscitation from hemorrhagicshock M l／／Ivatury RR，eds．Penetrating trauma． NewYork：Williams Wilkim。),CLS,機(jī)制(jīzh236。nz233。,3.1 處理原發(fā)病、減輕應(yīng)激程度減少炎性介質(zhì)的作用。 3.2 維持有效循環(huán)血容量,11/11/2024,28,3.treatment,第二十八頁，共四十六頁。o)是CLS治療的關(guān)鍵 ? 應(yīng)根據(jù)不同階段病理生理特點(diǎn)選擇恰當(dāng)?shù)囊后w種類 ? 不同液體各有優(yōu)點(diǎn)，如何使用存在爭議,11/11/2024,European Journal of Anaesthesiology 2003。 生化特性(t232。 低相對分子質(zhì)量、低取代級及低C2／C6比率羥乙基淀粉其擴(kuò)容持續(xù)時(shí)間雖不如高相對分子質(zhì)量者，但對紅細(xì)胞聚集和血漿黏滯度等血液流變學(xué)指標(biāo)的改善作用均強(qiáng)于后者。 容量效率低而腎功能影響大 體內(nèi)蓄積時(shí)間長， 20天 變態(tài)反應(yīng)率較高 無堵塞和防止毛細(xì)血管滲漏作用,11/11/2024,31,第三十一頁，共四十六頁。zh236。,膠體溶液容量效力(xi224。) 100% 6小時(shí) 12小時(shí) 30%,11/11/2024,35,第三十五頁，共四十六頁。,CLS 滲漏(sh232。,CLS 恢復(fù)期,恢復(fù)期毛細(xì)血管通透性逐漸恢復(fù)，大分子物質(zhì)回流(hu237。 此期應(yīng)在嚴(yán)密監(jiān)測下進(jìn)行液體治療，一般 需要限制補(bǔ)液甚至應(yīng)用利尿藥物。應(yīng)用呼吸機(jī)輔助通氣 支持呼吸，維持有效的通氣與挽氣功能，改善氧合，糾正低氧血 癥。o x236。,11/11/2024,42,第四十二頁，共四十六頁。i le)減輕炎性反應(yīng)或促進(jìn)某些抑制炎性反應(yīng)的 物質(zhì)釋放，達(dá)到減輕炎性反應(yīng)的療效。,Hydroxyethyl Starch 130 /0.4: Does“Modern Modern”Mean Safe?,HES 130/0.4 is promoted for its rapid plasma clearance, which does not, however, imply low tissue storage. One third of administered HES 130/0.4 cannot be recovered in plasma or urine within 24 h an even greater proportion than that for HES 450/0.7 (19%–23%). Greater tissue storage might be related to the high C2/C6 ratio of HES 130/0.4 (9 vs 5 for HES 450/0.7). In a new case report, a patient receiving HES 130/0.4 for septic shock developed acute renal failure with biopsyproven osmotic nephrosis. In conclusion, before alleging its safety, HES 130/0.4 needs to be evaluated in rigorous large scale randomized trials. International Anesthesia Research Society ，Vol. 109, No. 4, October 2009,11/11/2024,45,第四十五頁，共四十六頁。一層內(nèi)皮細(xì)胞+基膜組成+少許結(jié)締組織。y232。C/C
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