Gatti J E, LaRossa D, Neff S R, Silverman D G
Surgery. 1982 Aug;92(2):200-5.
Isovolemic hemodilution is known to reduce blood viscosity. Reduction of either the blood cell concentration or the serum total protein has been found to improve blood flow and ultimate survival of skin flaps. Nutritive blood flow and tissue survival were examined in dorsal pedicle skin flaps in three groups of rats at three hematocrit levels--44% (controls), 31%, and 19%. After hemodilution by phlebotomy and crystalloid replacement, the dye kinetics of intravenously administered fluorescein were measured with the fiberoptic perfusion fluorometer. Skin flap survival at the different hematocrits were also examined. Hematocrits and serum total protein were measured before and after hemodilution and the elevation of the flap. The rate of fluorescein elimination and ultimate flap survival were significantly augmented in the two hemodiluted groups. The maximum benefit was seen in the group of animals hemodiluted to 19%. However, significant improvement in blood flow and skin flap survival was noted in the group of animals that were hemodiluted to a more clinically acceptable level (31%). The decreases in serum total protein following flap elevation did differ among the groups. This study supports the hypothesis that isovolemic hemodilution may be a valuable technique for salvaging marginally ischemic tissues.
已知等容性血液稀释可降低血液粘度。业已发现，降低血细胞浓度或血清总蛋白均可改善皮瓣的血流及最终成活率。在三组大鼠中，于三种血细胞比容水平（44%（对照组）、31%和19%）下，对带蒂背部皮瓣的营养性血流及组织存活情况进行了研究。通过放血及晶体液置换进行血液稀释后，使用光纤灌注荧光计测量静脉注射荧光素的染料动力学。还对不同血细胞比容下的皮瓣存活情况进行了检查。在血液稀释前后及皮瓣抬高后，测量血细胞比容及血清总蛋白。两个血液稀释组的荧光素清除率及皮瓣最终成活率均显著提高。在血细胞比容稀释至19%的动物组中观察到最大益处。然而，在血细胞比容稀释至更接近临床可接受水平（31%）的动物组中，血流及皮瓣存活情况有显著改善。皮瓣抬高后血清总蛋白的降低在各组间确实存在差异。本研究支持这样的假说，即等容性血液稀释可能是挽救边缘性缺血组织的一项有价值的技术。
