Shah D M, Powers S R, Bernard H R, Scovill W A, Newell J C, Stratton H H
Surgery. 1980 Nov;88(5):686-92.
To study the isolated effects of decreased hemoglobin concentration without volume loss, eight patients with the diagnosis of polycythemia were studied following acute phlebotomy and simultaneous volume replacement. These patients had been treated previously by repeated phlebotomy, without volume replacement, to a hemoglobin level of 14.8 +/- 0.5 gm%. Following hemodilution by additional phlebotomy and volume replacement, which further lowered the mean hemoglobin level to 11.4 +/- 0.4 gm%, cardiac index increased significantly from 2.8 +/- 0.3 to 3.5 +/- 0. 3 liter/min/m(2) (P<0.05), oxygen delivery did not change, but total body oxygen consumption increased significantly from 140 +/- 16 to 180 +/- 15 ml/min/m(2) (P<0.05). Mixed venous PO2, systemic and pulmonary vascular resistance decreased significantly (P<0.05). Vascular pressure, heart rate, intrapulmonary shunt, arterial pH and bicarbonate, limb blood flow, limb oxygen delivery and limb oxygen consumption did not change. Thus, with phlebotomy and fluid replacement, a reduction of hemoglobin concentration to a subnormal level increased oxygen consumption without lowering oxygen delivery.
为研究无容量丢失情况下血红蛋白浓度降低的单独作用，对8例诊断为红细胞增多症的患者在急性放血及同时进行容量替代后进行了研究。这些患者此前曾通过反复放血（未进行容量替代）治疗，使血红蛋白水平降至14.8±0.5克%。在通过额外放血和容量替代进行血液稀释后，平均血红蛋白水平进一步降至11.4±0.4克%，心脏指数从2.8±0.3显著增至3.5±0.3升/分钟/平方米（P<0.05），氧输送未改变，但全身氧耗量从140±16显著增至180±15毫升/分钟/平方米（P<0.05）。混合静脉血氧分压、体循环和肺血管阻力显著降低（P<0.05）。血管压力、心率、肺内分流、动脉pH值和碳酸氢盐、肢体血流量、肢体氧输送和肢体氧耗量均未改变。因此，通过放血和液体替代，将血红蛋白浓度降至正常以下水平可增加氧耗量而不降低氧输送。
