急性高容量性血液稀释对妇科肿瘤患者围术期T淋巴细胞亚群的影响

目的探讨急性高容量性血液稀释(AHH)对妇科肿瘤患者围手术期T淋巴细胞亚群的影响.方法40例ASAⅠ～Ⅱ级的妇科肿瘤手术病人随机分成两组:高容量性血液稀释组(A组)在切皮前30分钟内输入6%羟乙基淀粉液1000ml;对照组(C组)常规输液,不实施血液稀释.分别与麻醉诱导前、手术结束后、术后24小时抽取静脉血,用流式细胞仪测定T淋巴细胞亚群CD3 、CD4 、CD8 及CD4 /CD8 细胞百分率.结果两组病人手术结束后(T1)、手术后第1天(T2)与麻醉诱导前(T0)比较:T淋巴细胞亚群CD3 、CD4 及CD4 CD8 均明显降低(P＜0.01或P＜0.05),CD8 无显著性变化;但A组手术结束后和手术后第1天CD3 、CD4 及CD4 /CD8 明显高于C组(P＜0.05).结论术前采用急性高容量性血液稀释(AHH),可显著改善妇科肿瘤患者T淋巴细胞的免疫功能.     

Influence of different preservation solutions and intentional hemodilution of recipient on viability of preserved and transplanted rat kidneys

Abstract. A total of 81 rat kidney grafts, flushed out and cold stored in either Sacks' or University of Wisconsin (UW) solution, were transplanted into hemodiluted (Hct = 30%± 4%) or untreated (Hct = 43%± 3%) recipients. The cold ischemia times (CIT) used were 24 and 36 h. One week after transplantation, the surviving recipients ( n = 67) were contralaterally nephrectomized. The experiment was terminated after a total period of 4 weeks, and the percentage of surviving animals was determined for each treatment. Data was pooled and the results show that grafts cold stored in UW solution were viable to a significantly greater extent and after longer CIT than grafts cold stored in Sacks' solution (47% vs 23%; P < 0. 05). Recipient hemodilution did not improve graft viability (39% vs 32%; NS). Kidneys cold stored for 24 h were viable to a greater extent than kidneys with a CIT of 36 h (50% vs 15%; P < 0. 01).     

食管超声多普勒监测急性高容量血液稀释对血液动力学的影响

目的　应用经食管超声多普勒血液动力学监测仪 ,观察全麻下急性高容量血液稀释(HHD)的血液动力学和氧供 (DO2 )变化。方法　选择 1 5例ASAI～II级择期行非心脏手术患者。麻醉诱导插管后持续监测心输出量 (CO)、每搏量 (SV)、心脏指数 (CI)、血流峰速度 (PV)、血流加速度(Acc)和左室射血时间指数 (LVETi) ,每隔 5分钟输入MAP值后计算出系统血管阻力 (SVR)值。麻醉平稳和各项监测完成后 1 0min ,在 30min内输注 6 %羟乙基淀粉 (HES) 2 0ml/kg。记录 6 %HES输注前、输注 1 5和 30min时的各项监测数据 ,并抽取动脉血液样本行血气分析并计算DO2 。结果　与HHD前相比 ,血气各参数 (pH、PaO2 、PaCO2 、BE)均无明显差异 (P >0 0 5 ) ,而 6 %HES输注 1 5和30min血红蛋白 (Hb)含量、红细胞比积 (Hct)均明显下降 (P <0 0 5和P <0 0 1 )。 6 %HES输注 1 5和 30min时的CaO2 比HHD前明显下降 (P <0 0 5 ) ,而DO2 显著增加 (P <0 0 5 )。与HHD前测量值相比 ,6 %HES输注 1 5min ,CO、SV、CI、PV和Acc明显升高 ,SVR显著降低 (P <0 0 5 ) ;6 %HES输注 30min ,SV、PV和Acc进一步升高 (P <0 0 1 ) ,而CO、CI和SVR与 6 %HES输注 1 5min时无明显变化。MAP、HR和LVETi在HHD期间无明显变化。结论　术前输注 6 %HES 2 0ml     

控制性降压结合急性高容血液稀释在脑膜瘤手术中的应用

目的　观察控制性降压结合急性高容血液稀释 (AHH)对脑膜瘤手术的安全性及减少出血量和术后血红蛋白 (Hb)、红细胞比积 (Hct)的影响。　方法　择期脑膜瘤手术病人 2 0例 ,随机分成控制性降压结合AHH组 (Ⅰ组 ,n =10 )和对照组 (Ⅱ组 ,n =10 ) ,两组均采用气管内全麻。Ⅰ组病人于气管插管后手术开始前完成AHH并进行控制性降压。比较两组病人术中出血量、输血量和术后Hb、Hct变化。　结果　Ⅰ组病人术中平均出血量 (5 44± 92 )ml ,比Ⅱ组病人的 (10 72± 182 )ml减少 49 7% ;Ⅱ组病人平均输血量 (62 0± 112 )ml ,Ⅰ组病人则完全避免输异体血。两组病人术毕均有轻度贫血 ,但仍在安全水平范围内。　结论　控制性降压结合急性高容血液稀释可安全应用于脑膜瘤手术 ,对有指征病人的使用可避免术中输异体血     

急性超容血液稀释对血流动力学的影响

目的 观察不同人工胶体液行急性超容血液稀释(AHHD)对血流动力学的影响.方法 45例ASA Ⅰ～Ⅱ级腹部手术患者,随机分为3组:对照组(C组)、6%羟乙基淀粉组(H组)及4%琥珀酰明胶组(G组).在麻醉诱导后开始输液或扩容:C组输入林格液15 ml/kg,H、G组输入林格液15 ml/kg和胶体液20 ml/kg,均在40 min内完成.监测3组术前、麻醉诱导后、输液或扩容20 min、输液或扩容40 min时心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI),外周血管阻力(SVR)的变化.监测H、G组患者扩容前后血细胞比容(Hct)的变化.结果 H、G组在扩容末,Hct下降,H组由术前0.385±0.043降至0.304±0.045,G组由术前0.395±0.035降至0.312±0.038.H、G组HR、MAP、CI、CVP、SVR术前值和麻醉诱导后值与C组的差异没有统计学意义(P>0.05).输液或扩容20 min、输液或扩容40 min时H、G组HR、CI、CVP、MAP高于C组,其差异有统计学意义(P<0.05);在扩容20 ml/kg后H组CVP增高达(13.13±3.51)cm H2O(1 cm H2O=0.098 kPa),G组增加达(14.88±1.33)cm H2O.结论 在40 min内静脉输入20 ml/kg的6%羟乙基淀粉、4%琥珀酰明胶,是一种有效的超容血液稀释方法.但会造成心脏负荷的显著增加,使用异氟醚和硝酸甘油能有效地减轻心脏前负倚.     

Responsiveness of the ANP providing system to volume load in conscious dogs

We examined in detail changes in arterial plasma ANP concentration in response to volume load in conscious dogs. In a 5-min volume load experiment, 18 ml/kg of isosmotic and isooncotic 3% Dextran 40 in saline was infused over a period of 5 min. Mean left atrial pressure (MLAP) increased transiently by 7.6±0.9 mm Hg. Plasma ANP level (P-ANP) did not significantly increase. Assayed P-ANP levels were corrected for hemodilution. Corrected P-ANP (C-ANP) significantly increased from 206±17 to 348±34 pg/ml. However, the level of C-ANP did not reach a steady state. No significant linear correlation was found between increases in MLAP and normalized C-ANP. In a 45-min volume load experiment, the elevated level of MLAP caused by the 5-min volume load was maintained for 40 min by supplemental infusion. C-ANP significantly increased from 196±18 pg/ml to 435±73 ng/ml. The level of C-ANP reached a steady state. A close linear correlation was observed between increases in MLAP and normalized C-ANP. However, the peak time of C-ANP lagged 10 min behind MLAP. These results indicate that it takes 10 min for P-ANP to reach a steady state in fully responding to a volume load, and that the long-term volume load is a prerequisite to the response of the ANP providing system.     

Vergleichende Untersuchung von niedermolekularem Dextranoder Hydroxyäthylstärkelösungen als Volumenersatzmittel bei Hämodilutionstherapie

Summary Rheological therapy, as an immediate treatment in conjunction with physical therapy and the removal of risc factors, plays a significant role in the management of patients with peripheral vascular disease experiencing reduced walking tolerance. An essential element of rheological therapy is hemodilution. Currently, is still uncertain which plasma substitute solution would be the most appropriate in such cases. This study compared the effectiveness of low molecular hydroxyethyl starch to low molecular dextran during a 16-day hemodilution in combination to physical therapy. The clinical improvement observed with both plasma substitute solutions was comparable, yet in view of the cardiac volume overload, dextran demonstrates greater circulatory stress due to the transient pressure increase and more side effects. For this reason, we prefer to administer low or middle molecular hydroxyethyl starch in the dilution treatment of peripheral arterial occlusive disease as a chronic degenerative vascular disease.

---

Abkürzungen A2M Alpha-2-Makroglobulin - D0 Meßzeitpunkt 0 der später mit Dextran behandelten Gruppe - D1 Meßzeitpunkt 1 der Dextran-Gruppe - D2 Meßzeitpunkt 2 der Dextran-Gruppe - Dextran 40 kleinmolekulares Dextran (mittleres Molekulargewicht 40000 Dalton) - ETA Plasmaviskosität - Fib Fibrinogen - Geh Gehstrecke - H0 Meßzeitpunkt 0 der später mit Hydroxyäthylstärke behandelten Gruppe - H1 Meßzeitpunkt 1 der HAES-Gruppe - H2 Meßzeitpunkt 2 der HAES-Gruppe - HAES 40 kleinmolekulare Hydroxyäthylstärke (mittleres Molekulargewicht 40000 Dalton) - Hkt Hämatokrit - LZ Leukozyten-Zahl - Pro Gesamteiweiß - SEA Erythrozyten-Aggregationsindex - SER Erythrozyten-Rigiditätsindex - TY Fließschubspannung - TZ Thrombozyten-Zahl     

等容血液稀释对大鼠局灶性脑缺血作用的研究

以血液稀释治疗血栓栓塞性脑缺血为目的,采用大脑皮层局部血流量(rCBF)、脑组织含水总量以及脂质过氧化物含量(LPO)为重要指标,共71只大鼠的实验研究,结果表明:大脑局灶性缺血24小时后经血液稀释治疗2小时,血细胞压积由49.4±3.5%降至39.3±3.77%,rCBF增加19.95%(n=16,P<0.005),脑组织含水量及LPO含量,对照组与稀释组分别为81.39±1.56%(n=12),79.00±1.08%(n=13,P<0.001);645.57±106.72nmol/100mgpro(n=11),360.47±117.46nmol/100mgpro,(n=14,P<0.001)。提出血液稀释可增加rCBF,减轻脑水肿,降低LPO。     

颅脑肿瘤手术行急性等容血液稀释的临床研究

目的：研究急性等容血液稀释对颅脑肿瘤病人血流动力学、氧转运及凝血纤溶方面的影响,探讨该方法的安全性。方法：选择颅脑肿瘤手术病人12例,麻醉后从右颈内静脉放置Swan～Ganz导管,从桡动脉放血8ml/kg,同时等速从静脉输入等量的海脉素。分别测定血液稀释前后的血流动力学,氧转运及凝血纤溶方面的指标。结果：CO、SV、DO2显著增加(P＜0.05);PT延长(P＜0.05);PLT较血液稀释前减少,其余指标无明显改变。结论：急性等容血液稀释对颅脑肿瘤病人的血流动力学及凝血纤溶功能影响小,而氧供增加,是一安全有效的血液保护方法。     

急性非等容血液稀释对开颅病人颅内压及凝血功能影响

目的 探讨急性非等容血液稀释对开颅病人的颅内压和凝血功能的影响。方法 选择择期开颅肿瘤切除病人18例，麻醉诱导前行蛛网膜下腔穿刺，监测颅内压(ICP)，并由足背动脉放血400—600ml，开始诱导同时经外围静脉快速补充2—2．5倍于采血量的等效肢体和晶体。麻醉采用静吸复合全麻，术中连续监测有创血压、心率、氧饱和度，分别于血液稀释前后监测ICP，中心静脉压(CVP)、活化部分凝血活酶(APTT)、凝血酶原时间(PT)、凝血因子1(FIB)、血小板(PLT)、血球压积(HCT)。结果 与血液稀释前相比，血流动力学稳定；PT明显延长(P＜0．05)，PLT、HCT明显降低(P＜0．05)，但仍在正常范围内，APTT、FIB差异无显著意义(P＞0．05)；颅内压无明显增高。结论 急性非等容血液稀释对开颅手术病人的颅内压和凝血功能无明显影响，是一种安全有效的、简便的血液保护方法。