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[血液稀释对冠心病患者心室功能的影响]

[Effects of hemodilution on the ventricular function of the coronary patient].

作者信息

Laxenaire M C, Aug F, Voisin C, Chevreaud C, Bauer P, Bertrand A

出版信息

Ann Fr Anesth Reanim. 1986;5(3):218-22. doi: 10.1016/s0750-7658(86)80146-0.

DOI:10.1016/s0750-7658(86)80146-0
PMID:3777543
Abstract

Ten patients (9 males and 1 female: mean age: 64.8 +/- 7 yr) were studied. They were all stabilized coronary heart disease patients free of cardiac failure who where to undergo normovolaemic haemodilution as medical treatment of lower limb arteritis. Ventricular function was assessed by a radioisotope method: myocardial perfusion (thallium-201 and dipyridamole scintillation scan) and left ventricular contraction by technetium-99m angiography. Blood volume was measured by iodine-131 marked albumin. The following parameters were also measured: plasma viscosity, blood viscosity at seven different speeds, red blood cell aggregation index and filtration index. These were all measured before and 24 h after normovolaemic haemodilution which was carried out with à 5% albumin solution. This haemodilution was well tolerated: 1,062 +/- 335 ml of blood were sampled, the same volume of albumin being transfused, thus reducing the mean haematocrit from 0.42 +/- 0.05 to 0.32 +/- 0.02 (p less than 0.01). Normovolaemia was respected. Blood viscosity was reduced, especially at low speeds and the red blood cell aggregation index was also reduced. Ventricular contraction did not vary. Moreover, the basal myocardial state as assessed by the thallium scintillation count was not modified by the haemodilution, even being improved in three cases. The dipyridamole perfusion (the equivalent of an effort test) gave no changes in seven patients, resolved the ischaemic signs in two patients and slightly increased ischaemia in one case.

摘要

对10例患者(9例男性,1例女性;平均年龄:64.8±7岁)进行了研究。他们均为稳定型冠心病患者,无心力衰竭,因下肢动脉炎接受等容血液稀释治疗。采用放射性核素方法评估心室功能:心肌灌注(铊 - 201和双嘧达莫闪烁扫描)以及通过锝 - 99m血管造影评估左心室收缩功能。通过碘 - 131标记的白蛋白测量血容量。还测量了以下参数:血浆粘度、七种不同速度下的血液粘度、红细胞聚集指数和滤过指数。这些参数均在使用5%白蛋白溶液进行等容血液稀释前及稀释后24小时测量。这种血液稀释耐受性良好:采集了1062±335毫升血液,输注了相同体积的白蛋白,从而使平均血细胞比容从0.42±0.05降至0.32±0.02(p<0.01)。维持了血容量正常。血液粘度降低,尤其是在低速时,红细胞聚集指数也降低。心室收缩功能未发生变化。此外,通过铊闪烁计数评估的基础心肌状态未因血液稀释而改变,甚至有3例得到改善。双嘧达莫灌注(相当于负荷试验)在7例患者中无变化,2例患者的缺血体征得到缓解,1例患者的缺血稍有增加。

相似文献

1
[Effects of hemodilution on the ventricular function of the coronary patient].[血液稀释对冠心病患者心室功能的影响]
Ann Fr Anesth Reanim. 1986;5(3):218-22. doi: 10.1016/s0750-7658(86)80146-0.
2
Normovolaemic haemodilution and hyperoxia have no effect on fractal dimension of regional myocardial perfusion in dogs.正常血容量性血液稀释和高氧对犬局部心肌灌注的分形维数没有影响。
Acta Physiol Scand. 1998 Apr;162(4):439-46. doi: 10.1046/j.1365-201X.1998.0289f.x.
3
Comparative study of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis.左主干冠状动脉狭窄患者有限度的控制性等容血液稀释的对比研究。
Anaesthesia. 1995 Nov;50(11):950-3. doi: 10.1111/j.1365-2044.1995.tb05926.x.
4
[Changes in coagulation physiology and rheology after preoperative normovolemic hemodilution].[术前等容血液稀释后凝血生理和流变学的变化]
Anasthesiol Intensivmed Notfallmed Schmerzther. 1996 Oct;31(8):481-7. doi: 10.1055/s-2007-995963.
5
Circulatory effects of acute normovolaemic haemodilution in rats with healed myocardial infarction.
Cardiovasc Res. 1989 Oct;23(10):842-51. doi: 10.1093/cvr/23.10.842.
6
Moderate normovolaemic haemodilution increases regional myocardial blood flow but has no effect on experimental infarct size.中度等容血液稀释可增加局部心肌血流量,但对实验性梗死面积无影响。
Scand J Clin Lab Invest. 1986 Nov;46(7):677-83. doi: 10.3109/00365518609083731.
7
[Isovolemic hemodilution in patients with coronary heart disease].[冠心病患者的等容血液稀释]
Klin Wochenschr. 1988;66 Suppl 15:8-14.
8
Rheological properties of commonly used plasma substitutes during preoperative normovolaemic acute haemodilution.
Br J Anaesth. 1996 Apr;76(4):519-25. doi: 10.1093/bja/76.4.519.
9
Haemorheological changes in patients with retinal vein occlusion after isovolaemic haemodilution.视网膜静脉阻塞患者等容血液稀释后的血液流变学变化
Br J Ophthalmol. 1990 Nov;74(11):665-9. doi: 10.1136/bjo.74.11.665.
10
Myocardial perfusion assessed with thallium-201 and left heart volume measured by radiocardiogram at rest and during exercise in patients with coronary artery disease.在冠状动脉疾病患者中,用铊-201评估静息和运动时的心肌灌注,并通过放射性心动图测量左心容积。
Jpn Circ J. 1981 Feb;45(2):163-70. doi: 10.1253/jcj.45.163.

引用本文的文献

1
[Blood-saving procedures--anesthesiologic aspects. Autotransfusion procedures at a large clinic].
Unfallchirurgie. 1989 Aug;15(4):194-200.
2
[Normovolemic hemodilution].[正常血容量血液稀释]
Can J Anaesth. 1991 Mar;38(2):243-51. doi: 10.1007/BF03008155.