Lundsgaard-Hansen P
University Department of Experimental Surgery, Inselspital, Berne, Switzerland.
Beitr Infusionsther. 1992;30:208-15; discussion 247-64.
In my opinion, the problem of a 'critical hematocrit' can be summarized in five contentions: First, it is inadmissible to label any single hemoglobin or hematocrit value as being generally acceptable, the reason being, second, that the adequate values differ between patients and sometimes also between various stages of their individual course--for instance during the intra- and the postoperative period. Third, a hemoglobin or hematocrit within the normal range constitutes a natural buffer against encroachments upon the oxygen supply from non-Hb causes. Intentional manipulation of this buffer requires a careful assessment of potential benefits vs. risks. Fourth, a patient in otherwise perfect condition tolerates a hemoglobin or hematocrit below 10 g/dl or 30%, respectively, down to approximately 8 g/dl or 25%- but tolerance is not necessarily equivalent to an optimum. And fifth, the patient most dependent on his 'hemoglobin buffer' is the individual who has to overcome troubles without the monitoring facilities of an intensive care unit, for instance in the peripheral hospital equipped only for primary care.
在我看来，“临界血细胞比容”问题可归纳为五点：其一，将任何单一血红蛋白或血细胞比容值视为普遍可接受是不可取的，其二，原因在于患者之间以及个体病程的不同阶段（例如术中及术后阶段），合适的值存在差异。其三，正常范围内的血红蛋白或血细胞比容构成了抵御非血红蛋白因素对氧供应侵害的天然缓冲。对这种缓冲进行有意操控需要仔细评估潜在益处与风险。其四，在其他方面状况良好的患者可耐受血红蛋白或血细胞比容分别低于10g/dl或30%，直至约8g/dl或25%，但耐受并不一定等同于最佳状态。其五，最依赖其“血红蛋白缓冲”的患者是那些在没有重症监护病房监测设施的情况下必须克服困难的人，例如在仅配备初级护理的基层医院。
