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短暂性肺止血的血流动力学效应

Hemodynamic effects of brief pulmonary hemostasis.

作者信息

Yang G G, Sadurski R, Bhattacharya J

机构信息

St. Luke's-Roosevelt Hospital Center, Columbia University, New York, New York 10019.

出版信息

J Appl Physiol (1985). 1993 Aug;75(2):948-54. doi: 10.1152/jappl.1993.75.2.948.

Abstract

We determined the hemodynamic effects of brief hemostasis in isolated blood-perfused rat lungs held at constant inflation pressure. Three periods of hemostasis, each lasting 20 min, alternated with equal durations of perfusion. Pulmonary vascular resistance (PVR), calculated as the ratio of the pulmonary arterial- (Ppa) left atrial (Pla) pressure difference to flow, was determined at baseline and after the third hemostasis period. Hemostasis increased PVR by 127% above baseline at constant Ppa and Pla (n = 8; P < 0.05) and by 71% at constant Pla and constant flow (n = 16; P < 0.05). The PVR increases were significantly attenuated by platelet (n = 5) or red blood cell (n = 4) removal from the lung perfusion, mechanical ventilation (n = 5), indomethacin (2 X 10(-6) M; n = 5), papaverine (10(-5) M; n = 4), and the thromboxane blocker SQ-29548 (7.8 X 10(-5) M; n = 4). By micropuncture we determined that the posthemostasis increase of the total pressure drop was 66% due to an increase of the venous pressure drop (P < 0.05). Isogravimetric pressure and lung water were not significantly altered by hemostasis. We conclude that brief hemostasis in the rat lung induces platelet- and red blood cell-dependent increase of vascular resistance. This effect may be attributable to hemostasis-induced platelet activation leading to thromboxane release.

摘要

我们测定了在恒定充气压力下,短暂止血对离体血液灌注大鼠肺脏血流动力学的影响。三个20分钟的止血期与相同时长的灌注期交替进行。肺血管阻力(PVR)通过肺动脉压(Ppa)与左心房压(Pla)之差与血流量的比值计算得出,分别在基线和第三个止血期后进行测定。在Ppa和Pla恒定的情况下,止血使PVR比基线升高了127%(n = 8;P < 0.05);在Pla和血流量恒定的情况下,PVR升高了71%(n = 16;P < 0.05)。从肺灌注中去除血小板(n = 5)或红细胞(n = 4)、机械通气(n = 5)、吲哚美辛(2×10⁻⁶ M;n = 5)、罂粟碱(10⁻⁵ M;n = 4)以及血栓素阻滞剂SQ - 29548(7.8×10⁻⁵ M;n = 4),均可显著减弱PVR的升高。通过微穿刺我们确定,止血后总压降升高了66%,这是由于静脉压降升高所致(P < 0.05)。等重力压力和肺含水量未因止血而发生显著改变。我们得出结论,大鼠肺脏的短暂止血会导致依赖血小板和红细胞的血管阻力增加。这种效应可能归因于止血诱导的血小板活化导致血栓素释放。

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