急性高容量血液稀释对脑氧代谢的影响

目的观察急性高容量血液稀释（AHH）对脑氧代谢的影响,探讨AHH是否改变脑氧代谢的平衡。方法选择44例行肝叶部分切除的患者,随机分为实验组（H组,n=22）和对照组（C组,n=22例）。测定血气值和乳酸（LA）值,计算脑氧摄取率（CEO2）、桡动脉-颈内静脉血氧含量差（Da-jvO2）和颈内静脉-桡动脉血乳酸差（VADL）。结果H组在稀释后SjvO2升高,CEO2和Da-jvO2降低（P〈0.01）,其中有3例患者在稀释后SjvO2〉90%;其余患者SjvO2均在正常范围内,而C组中所有患者SjvO2均未超过80%。稀释后与C组比较,H组SjvO2升高,CEO2、Da-jvO2降低（P〈0.05）。结论AHH可以改善脑氧代谢,不会发生脑氧供不足,但有小部分患者可能会发生不同程度的脑血流灌注过剩问题。     

急性高容量血液稀释联合硝酸甘油控制性降压的临床观察

目的 观察术中急性高容量血液稀释(AHH)联合硝酸甘油控制性降压时血液动力学、氧代谢的变化,评价其可行性.方法 择期全麻手术病人40例,随机分为两组,每组20例.组Ⅰ为单纯AHH组,组Ⅱ为AHH联合应用硝酸甘油控制性降压(CH)组.组Ⅰ手术开始后在30 min内输入菲克雪浓15 mL/kg,CVP控制在16 cmH2O以内.组Ⅱ手术开始30 min内输注菲克雪浓15 mL/kg,同时以MAP基础值的70%为目标行CH.分别于麻醉诱导后(基础值,T0),AHH或AHH联合CH后30 min(T1),60 min(T2)记录血液动力学指标,同时采集中心静脉血,股动脉血测定血气及动脉血乳酸浓度(LAC),计算氧供(DO2),氧耗(VO2)和氧摄取率(ERO2).结果 AHH后,两组Hb、Hct在均明显下降(P＜0.01).组ⅠMAP、CVP明显升高(P＜0.01),组ⅡMAP、CVP无明显变化(P＞0.05).与T0比较,两组在T1、T2的DO2、VO2、LAC均无明显变化(P＞0.05).结论 AHH联合硝酸甘油CH,循环负荷增加少,CVP升高不明显,不易出现心力衰竭及肺水肿,能较好维持机体血液动力学和氧代谢的相对稳定,相对单纯AHH,临床应用更安全.     

急性高容血液稀释在腰椎爆裂骨折手术中的应用

为探讨术前急性高容血液稀释(AHH)应用于腰椎爆裂骨折手术的可行性。选择择期行腰椎爆裂骨折手术患者54例,随机分为2组:术前急性高容血液稀释组(A组)和常规输液组(B组),每组27例。A组术前输入乳酸钠林格液8ml·kg-1补充术前禁食量和6%中分子羟乙基淀粉万汶TM(6%HES130/0.4)15ml·kg-1行急性高容血液稀释;B组术前只输入乳酸钠林格液8ml.kg-1,术中同A组。观察AHH前、后,术毕A组和B组心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、凝血功能、血常规、血氧饱和度(SPO2)、出血量及输血量。结果A组AHH后心率(HR)、脉搏氧饱和度(SPO2)稳定,部分凝血活酶时间(APTT)升高(P<0.01);CVP升高(P<0.01);血小板计数(PC)降低(P<0.01);血红蛋白(Hb)、血细胞比容(Hct)下降,但所有变化都在正常范围内。A组输血2例,B组输血9例,差异有极显著性(P<0.01)。表明术前急性高容血液稀释(AHH)不影响凝血功能,明显减少了异体血的输注,并且循环稳定,可安全应用于腰椎爆裂骨折手术病人。     

急性等容血液稀释在肿瘤手术中的应用

目的:研究急性等容血液稀释(ANH)在肿瘤手术中的应用.方法:对30例食管或贲门癌病人行ANH,比较血液稀释前后血流动力学和血常规变化.结果:86.7%病人围手术期未输库血;血液稀释前、后30min以及自血回输后,心率、平均动脉压和血氧饱和度无显著性差异;稀释后30min与稀释前相比,血红蛋白、红细胞压积和红细胞显著减少(P＜0.05),但自血回输后无显著性差异,ANH对血小板无明显影响.结论:ANH可有效减少肿瘤病人手术中输入库血.     

急性高容量血液稀释对老年病人循环功能及心肌肌钙蛋白的影响

目的观察急性高容量血液稀释（AHH）对硬膜外麻醉下老年病人循环功能及心肌肌钙蛋白Ⅰ（CTnⅠ）的影响，探讨AHH在老年患者术中应用的安全性。方法选择ASAⅠ～Ⅱ级，无心肺疾患的硬膜外麻醉老年患者30例，随机分血液稀释组（H组）和对照组（C组），每组各15例。硬膜外麻醉成功后，H组按50ml／min的速率输注4％琥珀酰明胶15ml·kg^-1，C组输乳酸林格氏液15ml·kg^-1。麻醉前、切皮前、术毕、术后4h监测并记录SBP、DBP、HR、CVP、HCT、血气及心肌肌钙蛋白。结果硬膜外麻醉后两组血压均下降，C组下降较H组明显，H组实施AHH后CVP明显升高，但基本在正常范围之内。两组术叶1各时点血气分析变化差异无硅著性。CTnⅠ在组内各时点及组间相应时点差异无显著性（P〉0．05），且CTnI始终处在低值（≤0．1ng·ml^-1）。结论一般情况良好，无心肺疾患的老年患者硬膜外麻醉下实施AHH，循环功能影响较小，心肌损伤不明显。     

RENAL FUNCTION IN NEWBORN INFANTS WITH HIGH HEMATOCRIT VALUES BEFORE AND AFTER ISOVOLEMIC HAEMODILUTION

ABSTRACT. Aperia, A., Bergqvist, G., Broberger, O., Thodenius, K. and Zetterström, R. (Department of Paediatrics, St Göran's Children's Hospital, Kardinska Institutet, Stockholm, Sweden). Renal function in newborn infants with high hematocrit values, before and after isovolemic hernodilution. Acta Paediatr Scand 63: 878, 1974.—To evaluate the effect of high hematocrit (secondary polycythemia) on renal function in newborn babies, 10 infants with values above 70% have been studied before and after an isovolemic hemodilution. By replacing blood with a solution containing albumin, glucose and sodium chloride the hematocrit was reduced to about 60%. Hematocrit, blood viscosity, glomerular filtration rate (single injection technique), and the renal response to an oral sodium and fluid load were determined before and after hemodilution. The fall in hematocrit was accompanied by a concomitant fall in blood viscosity. All parameters of renal function which were studied were low before hemodilution but improved after this procedure. Water excretion increased out of proportion to glomerular filtration rate. It is suggested that the reduction in renal function as seen in newborn infants with high hematocrit are secondary to an impairment of glomerular plasma flow which in turn is the consequence of high viscosity. The depression of renal function as seen in polycythemic newborn infants may cause marked changes in the handling of certain drugs.     

局部脑缺血大鼠血液稀释治疗后脑区亮氨酸—脑啡肽含量的变化

采用大脑中动脉结扎的SD大鼠局部脑缺血模型,观察脑缺血24h及脑缺血22h后等容血液稀释治疗2h大鼠额叶皮质、下丘脑和垂体中亮氨酸—脑啡肽的含量。结果显示,脑缺血组此3个脑区亮氨酸—脑啡肽含量较假手术组明显增高(P<0.05或0.01),稀释治疗后均恢复至接近假手术组水平(P<0.01)。提示亮氨酸—脑啡肽可参与脑缺血的病理过程,血液稀释疗法也可能通过调节内源性阿片肽起作用。     

血液稀释治疗对急性脑梗塞血浆激肽释放酶原、蛋白C和蛋白S含量的影响

对16例接受等容血液稀释治疗及15例接受常规治疗的急性脑梗塞患者分别在治疗前、治疗后第5d和第30d检测血浆激肽释放酶原(PK)、蛋白C(PC)和蛋白S(PS)含量,并以20名健康者作正常对照。结果显示,治疗前两组患者各项指标均在正常范围,治疗后第5d稀释治疗组血浆PK含量显著下降(P<0.05),治疗后第30d稀释治疗组PC含量显著下降(P<0.05),未经稀释治疗的病例其相应指标无显著性变化。提示血液稀释疗法可能有提高脑梗塞患者抗凝系统的活性及调节凝血系统和抗凝系统平衡的作用。     

Colloids decrease clot propagation and strength: role of factor XIII-fibrin polymer and thrombin-fibrinogen interactions

Colloid-mediated hypocoagulability is clinically important, but the mechanisms responsible for coagulopathy have been incompletely defined. Thus, my goal was to elucidate how colloids decrease plasma coagulation function. Plasma was diluted 0% or 40% with 0.9% NaCl, three different hydroxyethyl starches (HES, mean molecular weight 450, 220 or 130 kDa), or 5% human albumin. Samples (n=6 per condition) were activated with celite, and diluted samples had either no additions or addition of fibrinogen (FI), thrombin (FIIa) or activated Factor XIII (FXIIIa) to restore protein function to prediluted values. Thrombelastographic variables measured included clot propagation (angle, alpha), and clot strength (amplitude, A; or shear elastic modulus, G). Dilution with 0.9% NaCl significantly decreased alpha, A and G-values compared to undiluted samples. Supplementation with FI, but not FIIa or FXIIIa, resulted in 0.9% NaCl-diluted thrombelastographic variable values not different from those of undiluted samples. FI supplementation of HES 450, HES 220, HES 130 and albumin-diluted samples only partially restored alpha, A and G-values compared to undiluted samples. FIIa addition only improved clot propagation and strength in albumin-diluted samples. FXIIIa supplementation improved propagation in samples diluted with HES 450, HES 220 and albumin, and clot strength improved in HES 450 and albumin-diluted plasma. Considered as a whole, these data support compromise of FIIa-FI and FXIIIa--fibrin polymer interactions as the mechanisms by which colloids compromise plasma coagulation. Investigation to determine if clinical enhancement of FXIII activity and/or FI concentration (e.g. fresh-frozen plasma, cryoprecipitate) can attenuate colloid-mediated decreases in hemostasis is warranted.