适度急性等容血液稀释改变冠状动脉疾病患者的心肌功能  

作　　者：Stefanie Cromheecke Suraphong Lorsomradee Philippe J. Van Stefan G. De Hert 肖洁(译) 王祥瑞(校) 

机构地区：[1]Department of Anesthesiology, ZNA Middelheim Antwerp, Belgium [2]Department of Anesthesiology, University Hospital Chiangmai, Chiangmai, Thailand [3]Department of Anesthesiology, Brugmann University Hospital-Children University Hospital Reine Fabiola,Brussels, Belgium [4]Department of Anesthesiology, University of Amsterdam, and Division of Cardiothoracic and Vascular Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands [5]不详

出　　处：《麻醉与镇痛》2009年第6期37-44,共8页Anesthesia & Analgesia

摘　　要：背景通常冠状动脉手术患者都能较好地耐受中度血液稀释，但这一情况并不适用于心肌氧需增加的患者。我们假设，在此类心率增快的患者中，血液稀释将导致心肌功能损害。方法根据房室起搏率将40例冠状动脉手术患者随机分为2组（n=20），房室起搏率70bpm（组70）和90bpm（组90）。按固定心率起搏下，在心肺转流术前实施血液稀释。通过肺动脉、PiCCO管和左室压力导管采集数据。所有的数据均取自等容稀释前后血流动力学稳定阶段。结果组70的血液稀释将血球压积从40％±2％降至30％±1％，组90的血液稀释将血球压积从39％±4％降到30％±2％，结果2组患者的体循环血管阻力均下降，而舒张末容积增加。组70患者伴有每搏量的增加，组90没有。组90在血液稀释后，最大压力上升速率下降[从856±93mmHg／s下降到716±80mmHg／s（P〈0．01）]，而组70的值保持不变（血液稀释前843±86mmHg／s，稀释后832±79mmHg／s）。结论本研究结果显示，中度血液稀释的患者，心率增加可能导致心肌功能的抑制。BACKGROUND： Although moderate hemodilution is usually well tolerated in coronary artery surgery patients, this may not be the case when myocardial oxy. gen demand is increased. We hypothesized that, in these patients, hemodilution in the presence of an increased heart rate could be associated with an impairment of myocardial function. METHODS： Forty coronary surgery patients were randomly assigned to two groups （n = 20）, according to the rate of atrioventricular pacing 170 bpm （Group 70） or 90 bpm （Group 90）1. While paced at the fixed heart rate, hemodilution was performed before the start of cardiopulmonary bypass. Data were obtained from a pulmonary artery, a PiCCO catheter and a left ventricular pressure catheter. Measurements were obtained in steadystate conditions before and after isovolemic hemodilution. RESULTS： Hemodilution from 40% ±2% to 30% ± 1% in Group 70, and from 39% ± 4% to 30% ± 2% in Group 90 resulted in a decrease in systemic vascular resistance and an increase in end-diastolic volume in both groups. This was associated with an increase in stroke volume in Group 70 but not in Group 90. In this latter group, the maximal rate of pressure development decreased significantly after hemodilution [from 856±93 to 716 ±80 mm Hg/s （P 〈 0.01）], whereas it remained unchanged in Group 70 （843 ±86 mm Hg/s before and 832 ±79 mm Hg/s after hemodilution）. CONCLUSIONS： In the conditions of the present study, increased heart rate during moderate hemodilution was associated with a depression of myocardial function.

关 键 词：急性等容血液稀释 冠状动脉手术 心肌功能损害 中度血液稀释 病患 心率增快 左室压力 血球压积 

分 类 号：R457.1[医药卫生—治疗学] R654.2[医药卫生—临床医学]