Perez de Sá V, Békássy A N, Schou H, Werner M U, Werner O
Department of Anesthesia and Intensive Care, University Hospital, Lund, Sweden.
Anesth Analg. 1991 May;72(5):645-50.
Eight children (1-17 yr) underwent bone marrow harvesting while in cytostatic-induced remission of their disease (leukemia [n = 6], Ewing sarcoma, and non-Hodgkin lymphoma). After the induction of general anesthesia, all patients were loaded with 10 mL/kg of a 6% high-molecular dextran solution (Macrodex--Pharmacia), which resulted in a significant preoperative decrease in hematocrit (Hct) from 32% +/- 6% to 28% +/- 5% (hypervolemic hemodilution) and also allowed the procedure to be performed without systemic heparinization. The blood aspirated during the harvest (24 +/- 6 mL/kg; mean +/- SD) was replaced with a solution of 6% dextran and Ringer's acetate solution, and the Hct decreased from 28% +/- 5% to a minimum of 18% +/- 3%. Immediately after the harvest, 10 mL/kg of homologous packed red blood cells was transfused, increasing Hct to 25% +/- 3%. Oxygen saturation in the superior caval vein (ScvO2) decreased from 79% +/- 4% before the harvest to 70% +/- 3% (P less than 0.01) at the end of it, and then increased to 74% +/- 3% after the transfusion of homologous packed red blood cells. There was a strong linear correlation between mean values for Hct and ScvO2 during the various stages (r = 0.99). Mean heart rate decreased gradually during the procedure, from 106 +/- 10 to 86 +/- 7 beats/min. There was no significant change in arterial pressure, but cardiac output measured by impedance cardiography was about 30% greater during harvesting than during undisturbed anesthesia. Pulse oximetric saturation was 99% or 100% throughout. Caval venous blood lactate and pyruvate concentrations remained within normal limits in all children.(ABSTRACT TRUNCATED AT 250 WORDS)
8名儿童（1 - 17岁）在其疾病（白血病[n = 6]、尤因肉瘤和非霍奇金淋巴瘤）处于细胞毒性诱导缓解期时接受了骨髓采集。全身麻醉诱导后，所有患者输注10 mL/kg的6%高分子右旋糖酐溶液（Macrodex - 法玛西亚公司），这导致术前血细胞比容（Hct）从32%±6%显著降至28%±5%（高容量血液稀释），并且使得该操作无需全身肝素化即可进行。采集过程中吸出的血液（24±6 mL/kg；均值±标准差）用6%右旋糖酐和林格氏醋酸盐溶液替代，Hct从28%±5%降至最低18%±3%。采集后立即输注10 mL/kg的同源浓缩红细胞，使Hct升至25%±3%。上腔静脉血氧饱和度（ScvO2）在采集前为79%±4%，采集结束时降至70%±3%（P < 0.01），输注同源浓缩红细胞后又升至74%±3%。在各个阶段，Hct和ScvO2的均值之间存在强线性相关性（r = 0.99）。术中平均心率逐渐下降，从106±10次/分钟降至86±7次/分钟。动脉压无显著变化，但通过阻抗心动图测量的心输出量在采集期间比未受干扰的麻醉期间约高30%。整个过程中脉搏血氧饱和度为99%或100%。所有儿童的腔静脉血乳酸和丙酮酸浓度均保持在正常范围内。（摘要截短于250字）
