Bishop M J, Cheney F W
Ann Surg. 1983 Jul;198(1):96-101. doi: 10.1097/00000658-198307000-00019.
Because of their multiple medical problems, patients with the adult respiratory distress syndrome (ARDS) often develop anemia. In order to determine the effects of a low hemoglobin concentration on gas exchange in such patients, the authors studied the effects of isovolemic hemodilution in the dog oleic acid model of ARDS. Twelve splenectomized dogs with oleic acid-induced pulmonary edema and a consequent venous admixture of 31% +/- 5% (mean +/- SEM) (FIO2 = 0.21) underwent two-stage isovolemic hemodilution with Hetastarch followed by retransfusion of the withdrawn red cells. This resulted in hemoglobin levels at each stage of 12.7 +/- 0.7 g/100 ml, 9.1 +/- 0.6 g/100 ml, 6.5 +/- 0.5 g/100 ml, and 10.1 +/- 0.5 g/100 ml (mean +/- SEM). Oxygen transport fell from 363 +/- 25 ml/kg/min to 219 +/- 17 ml/kg/min (p less than 0.001) at maximum hemodilution during air ventilation and from 383 +/- 79 ml/kg/min to 292 +/- 91 ml/kg/min (p less than 0.001) during oxygen ventilation. Since oxygen consumption remained constant throughout the hemoglobin range studied, decreased hemoglobin resulted in declines in P-VO2. Hemodilution with Hetastarch did not affect intrapulmonary shunt or venous admixture despite the significant increase in cardiac output associated with hemodilution.
由于患有多种医学问题，成人呼吸窘迫综合征（ARDS）患者常出现贫血。为了确定低血红蛋白浓度对此类患者气体交换的影响，作者在狗油酸诱导的ARDS模型中研究了等容血液稀释的效果。十二只脾切除的狗，因油酸诱导肺水肿，导致静脉血掺杂率为31%±5%（平均值±标准误）（吸入氧分数=FIO2=0.21），接受了用贺斯进行的两阶段等容血液稀释，随后回输所抽取的红细胞。这导致每个阶段的血红蛋白水平分别为12.7±0.7g/100ml、9.1±0.6g/100ml、6.5±0.5g/100ml和10.1±0.5g/100ml（平均值±标准误）。在空气通气时最大血液稀释期间，氧运输量从363±25ml/kg/min降至219±17ml/kg/min（p<0.001）；在氧通气时，从383±79ml/kg/min降至292±91ml/kg/min（p<0.001）。由于在所研究的血红蛋白范围内氧消耗量保持恒定，血红蛋白降低导致P-VO2下降。尽管血液稀释使心输出量显著增加，但用贺斯进行血液稀释并未影响肺内分流或静脉血掺杂。
