Carrillo ER, Sánchez GR

Idioma: Español
Referencias bibliográficas: 25
Paginas: 63-67
Archivo PDF: 111.53 Kb.

RESUMEN

La reanimación con cristaloides y concentrados eritrocitarios se asocian a alteraciones ácido-base. Mediante el modelo fisicoquímico de Stewart se abordan algunas de las consecuencias de la sobrerreanimación, como la expansión de volumen, la disminución en los niveles séricos de potasio y la acidosis metabólica hiperclorémica. La lesión secundaria a almacenamiento de los eritrocitos es causante del bajo aporte de oxígeno y lesión a la microcirculación, lo que determina disminución en la P50 y acidosis láctica. El objetivo de este trabajo es en base al caso de un enfermo con choque hipovolémico por hemorragia reportar los efectos deletéreos de la sobrerreanimación y del empleo de concentrados eritrocitarios con tiempo prolongado de almacenamiento.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Fencl V, Leith DE. Stewart’s quantitative acid-base chemistry: applications in biology and medicine. Respir Physiol 1993; 91: 1-16.

2. Grocott MPW, Mythen MG, Gan TJ. Perioperative fluid management and clinical outcomes in adults. Anesth Anal 2005; 100: 1093–1106.

3. Beutler E, West C. Storage of red cell concentrates in CPDA2 for 42 and 49 days. J Lab Clin Med 1983; 102: 53-62.

4. Greenwalt TJ, Zehner SC, Dumaswala UJ. Studies in red blood cell preservation. 2. Comparison of vesicle formation, morphology, and membrane lipids during storage in AS-1and CPDA-1. Vox Sang 1990; 58: 90-3.

5. Dumaswala UJ, Dumaswala RU, Levin DS, et al. Improved red blood cell preservation correlates with decreased loss of bands 3, 4.1, acetylcholinesterase, and lipids in microvesicles. Blood 1996; 87: 1612-6.

6. Dumaswala UJ, Rugg N, Greenwalt TJ. Studies in red blood cell preservation: 9. The role of glutamine in red cell preservation. Vox Sang 1994; 67: 255-9.

7. Wolfe L, Byrne A. A protection of red cell membrane from injury during liquid preservation of erythrocytes. Blood 1985; 66: 41A.

8. Knight JA, Searles DA, Clayton FC. The effect of desferrioxamine on stored erythrocytes. lipid peroxidation, deformability, and morphology. Ann Clin Lab Sci 1996; 26: 283-90.

9. Messana I, Ferroni L, Misiti F et al. Blood bank conditions and RBCs: the progressive loss of metabolic modulation. Transfusion 2000; 40: 353-60.

10. Tsai AG, Cabrales P, Intaglietta M. Microvascular perfusion upon exchange transfusion with stored red blood cells in normovolemic anemic conditions. Transfusion 2004; 44: 1626-34.

11. Hurd TC, Dasmahapatra KS, Rush BF et al. Red blood cell deformability in human and experimental sepsis. Arch Surg 1988; 123: 217-20.

12. Langenfeld JE, Livingston DH, Machiedo GW. Red cell deformability is an early indicator of infection. Surgery 1991; 110: 398-404.

13. Baker CH, Wilmoth FR, Sutton ET. Reduced RBC versus plasma microvascular flow due to endotoxin. Circ Shock 1986; 20: 127-39.

14. Mollitt DL, Poulos ND. The role of pentoxifylline in endotoxin-induced alterations of red cell deformability and whole blood viscosity in the neonate. J Pediatr Surg 1991; 26: 572-4.

15. Powell RJ, Machiedo GW, Rush BF Jr et al. Oxygen free radicals: effect on red cell deformability in sepsis. Crit Care Med 1991; 19: 732-5.

16. Hersch M, Gnidec AA, Bersten AD et al. Histologic and ultrastructural changes in nonpulmonary organs during early hyperdynamic sepsis. Surgery 1990; 107: 397-410.

17. De Backer D, Creteur J, Preiser JC et al. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002; 166: 98-104.

18. Hersch M, Bersten AD, Rutledge FS et al. Quantitative evidence of microcirculatory compromise in skeletal muscle of normotensive hyperdynamic septic sheep. Crit Care Med 1989; 17: S60.

19. Marik PE, Sibbald WJ. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993; 269: 3024-9.

20. Messmer K, Kreimeier U, Intaglietta M. Present state of intentional hemodilution. Eur Surg Res 1986; 18: 254-63.

21. Messmer KF. Acceptable hematocrit levels in surgical patients [review]. World J Surg 1987; 11: 41-6.

22. Fitzgerald R, Potter RF, Dietz G et al. The effect of transfusing aged red blood cells in oxygen supply dependency. Chest 1994; 106: 55S.

23. Sielenkamper AW, Chin-Yee IH, Martin CM et al. Diaspirin crosslinked hemoglobin improves systemic oxygen uptake in oxygen supply-dependent septic rats. Am J Respir Crit Care Med 1997; 156: 1066-72.

24. van Bommel J, de Korte D, Lind A et al. The effect of the transfusion of stored RBCs on intestinal microvascular oxygenation in the rat. Transfusion 2001; 41: 1515-23.

25. Scheingraber S, Rehm M, Sehmisch C,Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999; 90: 1265–1270.