手术病人轻、中度急性等容血液稀释时心脏代偿功能及心肌酶谱的改变

目的 :测定非心脏外科手术病人应用急性等容血液稀释 (ANHD)时 ,心输出量 (CO)、心脏射血量 (SV)及心肌酶谱的改变 ,评价心脏在氧供降低时的氧合情况及心肌是否缺氧受损。方法 :选择临床大中型非心脏外科手术病人 40例 ,ASAⅠ～Ⅱ级 ,麻醉平稳后正常体温下行ANHD ,测定不同程度血液稀释 (HD)时 (HD1、HD2 、HD3 的HCT分别约为 2 8% ,2 5 % ,2 3% ) ,心输出量 (CO)、心脏射血量 (SV)及心肌酶谱的改变。结果 :从HD1～HD3,即使在HD3 水平 ,CO(SV)下降时 ,心肌酶均未升高 ,回输血后心肌酶谱升高 ,与HD前比差异有显著性 (P <0 .0 5 )。结论 :手术病人进行轻、中度ANHD时 ,当CO(SV)降低 ,心脏失代偿时 ,未出现心肌酶的升高 ,再次说明心肌未受损

Cardiac Compensatory Mechanisms and Myocardial Enzymes Changes Undergoing Acute Normovolemic Hemodilution

Objective The increases in cardiac output(CO),stroke volume(SV)and tissue oxygen extraction are primary compensatory mechanisms activated by acute normovolemic hemodilution(ANHD).However ,this mechanism is limited .The present study investigates the changes in myocardiac enzymes to evaluate cardiac oxygen extraction.Methods Forty adults ASA class Ⅰ～Ⅱ patients undergoing non-cardiac surgery were administered a standard anesthesia.ANHD was accomplished by exchanging whole blood for 4% Gelofusine and got three different hemodlution(HD) levels:HD 1,HD 2 and HD 3.CO SV and myocardiac enzymes were measured.Results From HD 1 to HD 3, CO SV increased in HD 1 and HD 2 ,then decreased in HD 3. However, myocardiac enzymes did not increase in all HD levels. After reinfusion, myocardiac enzyme increased higher than initial level(P<0.05).Conclusion During ANHD, When CO, SV decreased, myocardiac enzymes did not increase.It is suggested that cardiac oxygen extraction is good when CO,SV decreased during ANHD.