Einfluss unterschiedlicher Konzepte zum primären Volumenersatz bei polytraumatisierten Patienten im Hinblick auf die primäre inflammatorische Entzündungsreaktion

Abstract

Influence of different primary volume replacement infusion concepts on inflammatory reactions in polytraumatic patients: Primary replacement of volume is a crucial step in the treatment of polytraumatic patients. We here investigated whether different infusion concepts can cause different effects on mediator release and therefore inflammatory processes. Three different infusion therapies (standard volume, small volume and lyoplasma) have been analysed in 38 out of 46 documented patients. 12 of them got a standard volume (control group), 13 a small volume and 13 lyoplasma therapy. Patients were classified according to the injury severity score into four injury categories. Only patients of the higher three severities were analysed. Within the severity groups, patients were further randomly grouped into the different infusion concepts. Results show that patients that received lyophilised plasma (lyoplasma) exhibited increased mediator release which points to a proinflammatory effect. In particular in group IV (severely injured) an enhanced release of thromboxan, prostaglandin F-2alpha , prostaglandin 1alpha und bicyclo-prostaglandin E2 could be observed. Serum concentration of C-reactive proteins were, however, not significantly different from the control group (standard volume infusion). In contrast to lyoplasma, infusion of small-volume caused remarkable low levels of thromboxan, prostaglandin F-2alpha , prostaglandin 1alpha und bicyclo-prostaglandin E2 in group IV (severly injured). Compared to patients in the control group (standard volume therapy), patients of group IV (severely injured) whith a small volume therapy showed a decreased concentration of nitrates in serum. Apart from that only small differences in mediator release could be detected between the control group and the small volume group. Taken together this study provides evidence that different infusion concepts cause different effects on mediator release.