血液稀释对心肌缺血和缺血再灌注心室功能及血液流变学的影响  

Effects of isovolumetric hemodilution on the ventricular function and hemorheology in dogs with myocardial ischemia and ischemic reperfused myocardium

作　　者：鄢文海[1] 汪丽娟[1] 汤宁[1] 杨培常 王金山[1] 王柏生[1] 黄幼田[1] 

机构地区：[1]河南医科大学病理生理学教研室,河南医科大学第一附属医院内科

出　　处：《河南医科大学学报》1996年第4期11-15,共5页Journal of Henan Medical University

基　　金：河南省自然科学基金

摘　　要：用四道生理记录仪和血液粘度检测法观测右旋糖酐４０等容稀释血液对犬心肌缺血和缺血再灌注后左心室功能（ｐＬＶＳ、ｐ±ｄｐ／ｄｔ－ｍａｘ）和血液流变学状态的影响。２４只犬随机均分为４组：１组为缺血组；２组为缺血再灌注组；３组为缺血＋稀释组；４组为缺血再灌注＋稀释组。结果：①血液流变学指标的改变：２组血液流变学状态于再灌注后较１组明显恶化，３、４组各项血液流变学指标在行血液稀释后较同期１、２组均明显改善（Ｐ＜０．０５）。②心功能的改变：２组于再灌注后各项心功能指标较１组显著降低；３组稀释后ｐＬＶＳ、ｐ＋ｄｐ／ｄｔ－ｍａｘ较１组明显升高；４组稀释后ｐＬＶＳ、ｐ＋ｄｐ／ｄｔ－ｍａｘ较２组显著升高（Ｐ＜０．０５），较３组有升高的趋势，但无明显差异（Ｐ＞０．０５），而ｐ－ｄｐ／ｄｔ－ｍａｘ较２、３组均明显升高（Ｐ＜０．０５）。提示：①缺血再灌注后血液流变性将进一步恶化，这可能是再灌注后心功能损伤加重的原因之一；②等容血液稀释对心肌缺血和缺血再灌注后左心功能均有保护作用，但对后者改善作用更明显。The effects of isovolumetric hemodilution on the left ventricular function (pLVS、p±dp/dt-max)and the abnormalities of hemorheologic parameters were compared in dogs with acute myocardial ischemia and ischemic reperfused myocardium. Twenty four dogs were divided at random into four groups, six dogs for each group. Group 1: ischemia group; Group 2 :ischemic reperfusion group; Group 3 :ischemia+hemodilution ; Group 4 :ischemic reperfusion +hemodilution, The results were as follows :①The changes of hemorrheologic indices: In Group 2, hemorheologic condition became worse as compared with those in Group 1 after reperfusion; In Group 3 and 4, all hemorheologic parameters decreased as compared with those in Group 1 and 2 after hemodilution (P<0.05).②The changes of cardiac functions:in Group 2, all cardiac function parameters decreased as compared with those in Group 1 after reperfusion; in Group 3, p+dp/dt-max and pLVS increased as compared with those in Group 1 after hemodilution (P<0. 05); in Group 4, p+dp/dt-max and pLVS increased significantly as compared with those in Group 2, and were higher than those in Group 3 , but p-dp/dt-max elevated significantly as compared with that either in Group 2 or 3. The results suggested that:①the exacerbation of hemorheologic peculiarity after ischemic reperfusion might be one of the factors that injure the cardiac function;②isovolumetric hemodilution could improve the left ventricular function of the ischemic myocardium and ischemic reperfusion myocardium, but the effects on the latter were greater than that on the former.

关 键 词：血液稀释 心肌缺血 再灌注 左旋糖酐 心脏功能 

分 类 号：R541.4[医药卫生—心血管疾病] R972[医药卫生—内科学]