Van der Linden P, Wathieu M, Gilbart E, Engelman E, Wautrecht J C, Lenaers A, Vincent J L
Department of Anaesthesiology, Erasme University Hospital, Free University of Brussels, Belgium.
Acta Anaesthesiol Scand. 1994 Jul;38(5):490-8. doi: 10.1111/j.1399-6576.1994.tb03935.x.
The cardiovascular effects of mild normovolaemic haemodilution during enflurane-nitrous oxide anaesthesia were studied in 20 patients with normal cardiac function before, during and after total hip replacement. After induction of anaesthesia, patients were randomly allocated to one control group (C), or one haemodiluted group (H) where Hct was decreased to 30% by replacement of blood volume by an identical volume of hydroxyethyl starch 200/05. Each patient was monitored with a pulmonary artery catheter allowing the measurement of right ventricular ejection fraction. During haemodilution, stroke index and right ventricular end-diastolic volume index increased from 33.1 +/- 7.9 to 39.3 +/- 7.1 ml.M-2 and from 73.8 +/- 20.3 to 94.9 +/- 18.5 ml.M-2 respectively (mean +/- s.d., both P < 0.05). However, heart rate decreased so that cardiac index did not change. O2 delivery decreased significantly (from 389 +/- 70 to 311 +/- 63 ml.min-1.m-2; P < 0.05), but was not different to the control group. O2 consumption was maintained by an increase in O2 extraction. During the surgical procedure, cardiac index was higher in the haemodiluted group than in the control group, so that O2 delivery was similar in the two groups. O2 consumption tended to be greater in the haemodiluted group. In patients with normal cardiac function, enflurane-nitrous oxide anesthesia could alter the normal physiologic response to mild normovolaemic haemodilution.
在20例心脏功能正常的患者行全髋关节置换术的过程中，研究了恩氟烷-氧化亚氮麻醉期间轻度等容性血液稀释对心血管系统的影响。麻醉诱导后，患者被随机分为一个对照组（C）和一个血液稀释组（H），在血液稀释组中，通过用相同体积的羟乙基淀粉200/05置换血容量使血细胞比容降至30%。每位患者均通过肺动脉导管进行监测，以测量右心室射血分数。血液稀释期间，每搏量指数和右心室舒张末期容积指数分别从33.1±7.9增加至39.3±7.1 ml·M⁻²和从73.8±20.3增加至94.9±18.5 ml·M⁻²（均数±标准差，P均<0.05）。然而，心率下降，因此心脏指数未改变。氧输送显著降低（从389±70降至311±63 ml·min⁻¹·m⁻²；P<0.05），但与对照组无差异。氧消耗通过氧摄取增加得以维持。手术过程中，血液稀释组的心脏指数高于对照组，因此两组的氧输送相似。血液稀释组的氧消耗倾向于更高。在心脏功能正常的患者中，恩氟烷-氧化亚氮麻醉可改变对轻度等容性血液稀释的正常生理反应。
