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急性等容血液稀释对高热及其物理治疗中心肺变化的影响。

Effects of acute normovolemic haemodilution on cardiorespiratory changes in hyperthermia and its physical treatment.

作者信息

Brozmanova A, Zila I, Javorka K, Porubcan J, Kapsova J

机构信息

Department of Physiology, Jessenius Faculty of Medicine, Comenius University, Malá Hora 4, 037 54 Martin, Slovakia.

出版信息

Int J Hyperthermia. 2004 Dec;20(8):851-64. doi: 10.1080/02656730410001714968.

Abstract

As only one experimental study examining the effects of haemodilution on circulatory responses to hyperthermia has so far been published and there is no information on respiratory responses to hyperthermia during haemodilution or anaemia, this paper studied the effects of acute normovolemic haemodilution on cardiorespiratory changes during 42 degrees C hyperthermia and its recovery by body surface cooling in 16 anaesthetized adult rabbits. The animals were divided into two groups: haemodiluted group (Hct = 18.6 +/- 0.4%) and control group (Hct = 41.1 +/- 0.9%). In the haemodiluted group, acute normovolemic haemodilution was induced by 60% replacement of total blood volume with dextran. Haemodilution produced significant increases in minute volume (V(E), p < 0.02), heart rate (HR, p < 0.02) and central venous pressure (CVP, p < 0.02), but there was no significant change in mean arterial pressure (MAP). Hyperthermia caused significant increases in V(E) and HR in both the groups; however, V(E) and HR values were significantly higher in the haemodiluted group compared to the controls. CVP decreased (p < 0.05) during 42 degrees C hyperthermia only in the controls in the panting phase. MAP did not significantly change during over-heating in controls, but it significantly (p < 0.02) rose in the haemodiluted group. In the recovery phase, cooling led to significant decreases in HR and MAP in both the groups and to further increases in V(E) (p < 0.05) in controls, whereas V(E) decreased in the haemodiluted animals. There were found no significant cardiorespiratory differences between the two groups during cooling. Hyperthermia was accompanied by the higher values of minute volume and heart rate in the haemodiluted animals, indicating a greater activation of the respiratory and cardiovascular systems, which could result in diminished functional cardiorespiratory reserve and a higher risk of respiratory and circulatory failures in haemodiluted/anaemic animals during hyperthermia. In the phase of recovery of the body temperature there were no significant cardiorespiratory differences found between the two groups.

摘要

由于迄今为止仅发表了一项关于血液稀释对热疗循环反应影响的实验研究,且尚无关于血液稀释或贫血期间热疗呼吸反应的信息,本文研究了急性等容性血液稀释对16只麻醉成年兔在42℃热疗期间心肺变化的影响以及通过体表降温恢复的情况。动物被分为两组:血液稀释组(血细胞比容 = 18.6 +/- 0.4%)和对照组(血细胞比容 = 41.1 +/- 0.9%)。在血液稀释组中,用右旋糖酐置换60%的全血容量诱导急性等容性血液稀释。血液稀释使分钟通气量(V(E),p < 0.02)、心率(HR,p < 0.02)和中心静脉压(CVP,p < 0.02)显著增加,但平均动脉压(MAP)无显著变化。热疗使两组的V(E)和HR均显著增加;然而,血液稀释组的V(E)和HR值显著高于对照组。仅在对照组气喘阶段的42℃热疗期间,CVP下降(p < 0.05)。对照组过热期间MAP无显著变化,但血液稀释组显著升高(p < 0.02)。在恢复阶段,降温使两组的HR和MAP显著下降,对照组的V(E)进一步增加(p < 0.05),而血液稀释动物的V(E)下降。降温期间两组之间未发现显著的心肺差异。热疗伴随着血液稀释动物更高的分钟通气量和心率值,表明呼吸和心血管系统的激活程度更高,这可能导致血液稀释/贫血动物在热疗期间心肺功能储备减少,呼吸和循环衰竭风险更高。在体温恢复阶段,两组之间未发现显著的心肺差异。

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