不同程度急性高容量血液稀释时家兔小肠和全身氧代谢的变化  

Effects of different degrees of acute hypervolemic hemodilution on systemic and intestinal oxygen metabolism in rabbits

作　　者：王晓艳[1] 李刚[1] 许永广[1] 孙巧梅[1] 

机构地区：[1]山东省立医院麻醉科,济南市250021

出　　处：《中华麻醉学杂志》2006年第7期612-614,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价不同程度急性高容量血液稀释(AHHD)对家兔小肠及全身氧代谢的影响。方法5月龄健康家兔12只,体重2．4-2．9kg。全身麻醉后,静脉输注4％琥珀酰明胶70ml-1·kg-1·h-1行AHHD,使Hct分别达到25％(H1)、20％(H2)、15％(H3)、10％(H4)4种程度,每种程度维持30 min。抽取股动脉、颈内静脉、肠系膜上动脉及肠系膜上静脉血标本,测定血液稀释前(H0)及4种程度下进行血气分析,测定血乳酸(Lac)浓度,计算动脉血氧含量(CaO2)、静脉血氧含量(CvO2)、氧摄取率(ERO2)、静脉-动脉乳酸含量差(v-aLac)。结果与H0比较,全身及小肠vLac、v-aLac在H4时升高,ERO2在H3、H4时升高(P<0．01);与H3比较,H4时ERO2、aLac、vLac、v-aLac升高(P<0．01);全身及小肠CaO2、CvO2随血液稀释程度的加深而降低(P<0．01)。全身及小肠血气分析结果与Lac变化趋势基本一致。结论Hct在15％～25％是保证家兔小肠和全身氧供的安全的血液稀释范围。Objective To investigate the effects of different degrees of acute hypervolemic hemodilution （AHH） on systemic and intestinal oxygen metabolism. Methods Twelve 5-month old rabbits of both sexes weighing 2.4-2.9 kg were anesthetized with ketamine and diazepam. The internal jugular vein （IJV）, femoral artery and superior mesenteric artery and vein were cannulated for BP and HR monitoring and blood sampling. 4% Gelofusine （ Braun Germany） was infused IV at 70 ml·kg^-1·h^-1. Hematocrit （Hct） was decreasing stepwise from baseline before colloid infusion （H0） to 25% （H1）, 20% （H2）, 15% （H3） and 10% （H4） . Blood samples were taken from IJV, femoral A and superior mesenteric A and V at H0 , H1 , H2 , H3 and H4 for blood gas analysis. CaO2, CvO2, oxygen extraction ratio （ERO2） and venous-arterial lactate concentration difference （v-aLac） of systemic and intestinal circulation were calculated.Results Systemic and intestinal venous blood lactate concentration （vLac） and v-aLac at H4 and ERO2 at H3 and H4 were significantly increased as compared to the baseline values at H0 （P 〈 0.01）. ERO2, aLac, vLac and v-aLac of both systemic and intestinal circulation were significantly higher at H4 than at H3 （ P 〈 0.01）. Systemic and intestinal CaO2 and CvO2 were decreasing as the degree of AHH was increasing. Conclusion AHH in the range of Hct 15 % -25 % is safe in terms of systemic and intestinal O2 supply.

关 键 词：血液稀释 氧耗量 小肠 

分 类 号：R614[医药卫生—麻醉学]