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Intravenous Air: The Partially Invisible Phenomenon

空氣注射在靜脈給藥期間是需要小心避免的。然而，環境里的空氣會溶解在需要注射的溶液中，當溶液在流體加溫系統和（或）體內加溫到正常體溫時，一部分氣體會以氣泡的形式從溶液中排出來。我們試圖在理論上測量在室溫時溶解的氣體的比例，以及4℃注射器中血液加熱到37℃排出的氣體比例。

根據亨利理論，在各種溫度下進行氯化鈉（0.9％），濃縮紅細胞和新鮮冷凍血漿的平衡溶解空氣計算。測量室溫時氯化鈉（0.9％）和4℃血液制品（濃縮紅細胞和新鮮冷凍血漿）在室溫水浴中加熱至37℃時的排出氣體體積。 測量到的氣體體積被認定為維持平衡飽和度所需的理論排氣量的一部分。

在每升液體的毫升氣體中測量的靜脈管道中的排氣體積分別為氯化鈉（0.9％）1.4±0.3mL / L（n = 6），濃縮紅細胞3.4±0.2mL / L（n = 6），新鮮冷凍血漿4.8±0.8mL / L（n = 6），當這些流體從各自的起始溫度升溫至體溫時，對于相同的流體和溫度，保持平衡飽和度所需的理論排氣體積分別為氯化鈉（0.9％）為4.7mL / L，濃縮紅細胞8.3mL / L，新鮮冷凍血漿10.9mL / L。作為理論排氣量的一部分，測量的空氣體積分別為氯化鈉（0.9％），濃縮紅細胞和新鮮冷凍血漿的30％，41％和44％。 在給藥前將晶體溶液預熱至37℃，可顯著減少了排氣。

在室溫溶液中存在明顯而潛在的與臨床有關的定量溶解氣體，4℃的紅細胞和血漿溶液在升溫至體溫后也會出現。 根據本研究的結果，這種排氣的很大一部分也預計會發生在體內循環中。這可以通過預熱來進行實質地預防。

原始文獻摘要

Varga C, Luria I, Gravenstein N. Intravenous Air: The Partially Invisible Phenomenon[J]. Anesthesia & Analgesia, 2016, 123(5):1149.

PURPOSE:

Air injection is carefully avoided during IV solution administration; however, ambient air is dissolved in all liquids used for intravenous (IV) therapy. A portion of this gas will come out of solution in the form of bubbles as the solution is warmed to body temperature in a fluid warming system and/or within the body. We sought to quantify the proportion of the gas theoretically dissolved in room temperature crystalloid and 4°C blood products that comes out of solution in the IV tubing on warming to 37°C.

METHODS:

Equilibrium-dissolved air calculations were performed for sodium chloride (0.9%), packed red blood cells, and fresh frozen plasma at various temperatures according to Henry’s Law. Outgassed gas volumes were experimentally measured for room temperature sodium chloride (0.9%) and 4°C blood products (packed red blood cells and fresh frozen plasma) warmed to 37°C during infusion into a body temperature water bath. The measured gas volumes were quantified as a fraction of the theoretical outgassing volumes required to maintain equilibrium saturation.

RESULTS:

Measured outgassed volumes in the IV tubing in milliliters of gas per liter of fluid were 1.4 ± 0.3 mL/L (n = 6) for sodium chloride (0.9%), 3.4 ± 0.2 mL/L (n = 6) for packed red blood cells, and 4.8 ± 0.8 mL/L (n = 6) for fresh frozen plasma when these fluids were warmed to body temperature from their respective starting temperatures. Theoretical outgassed gas volumes required to maintain equilibrium saturation for the same fluids and temperatures are 4.7 mL/L for sodium chloride (0.9%), 8.3 mL/L for packed red blood cells, and 10.9 mL/L for fresh frozen plasma. As a fraction of the theoretical outgassing volumes, the measured air volumes represented 30%, 41%, and 44%, respectively, for sodium chloride (0.9%), packed red blood cells, and fresh frozen plasma. Prewarming crystalloid solutions to 37°C before administration significantly reduced the outgassing.

CONCLUSION:

A significant and potentially clinically relevant amount of the resident dissolved gas in room temperature crystalloid, and 4°C packed red blood cells and plasma solutions comes out of solution on warming to body temperature. A nontrivial fraction of this outgassing

is also expected to occur within the body circulation based on the results of this study. This can be substantially prevented by prewarming.