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作 者:王清秀[1] 靳凤玲[1] 李钊[1] 金清尘[1]
机构地区:[1]北京医科大学附属第三医院麻醉科
出 处:《中华麻醉学杂志》1997年第5期272-275,共4页Chinese Journal of Anesthesiology
摘 要:目的:通过观察急性等容血液稀释(ANHD)时组织DO2、VO2的变化,寻找ANHD的生理极限。方法:10只健康成年杂种犬,用戊巴比妥钠、维库溴铵静脉麻醉后行气管内插管,控制呼吸。每只犬进行三个水平即中度(HD1)、深度(HD2)、极深度(HD3)ANHD,然后回输自家血,测定血流动力学指标,动脉及混合静脉血气,动脉血乳酸等,以观察ANHD时DO2、VO2的变化。结果:HD1(HCT=19.43%±1.97%),HD2(HCT=14.73%±0.99%)时,DO2分别降低42%和52%,ERO2分别升高40%和88%,CI升高41%和48%,而VO2只降低4.8%和5.2%,动脉血乳酸末升高。HD3(HCT=9.50%±0.88%)时,DO2降低73%,ERO2升高200%,CI降低,VO2降低35%,动脉血乳酸显著增加。回输自家血后,DO2、VO2及血乳酸均恢复。结论:中、深度HD时,DO2减少,VO2可通过增加ERO2和CI代偿;极深度HD时VO2降低显著,出现无氧代谢,HD达极限。Objective:To evaluate the effects of acute normovolemic hemodilution(ANHD) on systemic oxygen delivery(DO 2) and oxygen consumption(VO 2) for determining the acceptable limit of hemodilution(HD) Method:Ten healthy hybrid dogs,weighing 11 18kg,were anesthetized with 6% sodium pentobarbital,endotracheal intubation was facillitated with vecuronium,and ventilation was controlled The different degrees of ANHD,namely moderate(HD 1,HCT=19 43%),severe(HD 2,HCT=14 73%) and extreme(HD 3,HCT=9 50%)HD,were accomplished by progressively exchanging whole blood with 4% Gelofusion Blood gases,plasma lactate level (LA)and hemodynamic veriables were measured prior to HD and 30 mins following every degree of hemodilution and 15 mins after reinfusion Result:During the HD 1 and HD 2,Oxygen delivery(DO 2) decreased by 42% and 52% respectively (P<0 05);oxygen extraction ratio(ERO 2) increased by 40% and 88% respectively(P<0 05);cardiac index(CI) increased by 41% and 48% respectively(P<0 05);but oxygen consumption(VO 2) and plasma LA level did not change During the HD 3,DO 2 decreased by 73%(P<0 05);ERO 2 increased by 200%(P<0 05);CI decreased;VO 2 decreased by 35% and plasma LA level increased significantly(P<0 05) After reinfusion,DO 2 rose approximately to baseline;VO 2 also increased and much greater than the baseline(P<0 05),simultaneously plasma LA level decreased to the baseline Conclusion:Acute normovolemic hemodilution can be well tolereted until HCT drops to about 10% in dogs
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