晶体液的清除率与动脉压的关系
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Arterial Pressure and the Rate of Elimination of Crystalloid Fluid
背景与目的
全身麻醉时，术中晶体液排泄缓慢。
方 法
对林格缓冲液的分布和清除进行分析以确定清除率是否与血流动力学因素、意识、体位或全身麻醉的类型相关。数据从4项单独出版的研究中采集而来，包含了30名志愿者和48个麻醉妥当的患者接受0.833（1系列0.667）毫升/公斤/分钟的乳酸或醋酸林格氏液超过30分钟。输入快速检测出的血液血红蛋白和平均尿排泄率结果，根据二室模型进行动力学分析，并使用microconstants和混合效应模型软件进行相关变量分析。
结 果
结果表明，晶体液清除率降低与平均动脉压（MAP）和病人的年龄相关，但不受意识和吸入或静脉全身麻醉的影响。消除速率常数为6.5（95%置信区间为，5.2–7.9）×10−3×（MAP/平均MAP）5.2×（年龄/年龄）−1.5。2108个数据点的平均MAP为81.3mmHg，平均年龄为40岁。注入液体（VC、血浆量）对中央室分布容积的扩大情况会随体重而增加但会随全麻和MAP降低而下降。模拟试验显示，MAP为50或100毫米汞柱时，按理论输液30分钟后排出液体量有超过10倍的差异。
结 论
结论，晶体液的清除率与MAP成比例下降，但与全麻种类和中等大小手术并无关联。
原始文献摘要
Robert G. Hahn, MD, PhD.Arterial Pressure and the Rate of Elimination of Crystalloid Fluid.Anesth Analg.2017;XXX:00–00.
Abstract：
Excretion of crystalloid fluid is slow during general anesthesia. The distribution and elimination of buffered Ringer’s solution were analyzed to determine whether the rate of elimination correlates with a hemodynamic factor, consciousness, patient posture, or the type of general anesthesia.Data were derived from 4 separately published studies in which 30 volunteers and 48 anesthetized patients had received 0.833 (1 series 0.667) mL/kg/min of lactated or acetated Ringer’s solution over 30 minutes. Frequent measurements of the blood hemoglobin and mean urinary excretion were used as input in a kinetic analysis according to a 2-volume model and covariates, using microconstants and mixed-effects modeling software. The results show that rate of elimination of crystalloid fluid decreased with the mean arterial pressure (MAP) and patient age, but was unaffected by consciousness and inhalational or intravenous anesthesia. The elimination rate constant was 6.5 (95% confidence interval, 5.2–7.9)× 10−3 × (MAP/mean MAP)5.2 × (Age/mean Age)−1.5. The mean MAP for the 2108 data points was 81.3 mm Hg and the mean age was 40 years. The central fluid space that was expanded by infused fluid (Vc, plasma volume) increased with body weight but decreased with general anesthesia and with reductions of MAP.Simulations revealed a more than 10-fold difference in the excreted fluid volume after a theoretical 30-minute infusion, depending on whether the MAP was 50 or 100 mm Hg.
In conclusion, the rate of elimination of crystalloid fluid decreased in proportion to MAP but was independent of general anesthesia and moderate-sized surgery.
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