Bowens C, Spahn D R, Frasco P E, Smith L R, McRae R L, Leone B J
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.
Anesth Analg. 1993 May;76(5):1027-32. doi: 10.1213/00000539-199305000-00021.
The cardiovascular responses associated with isovolemic hemodilution have been described. However, the stability of these responses over time remains controversial. We hypothesized that the hemodynamic responses to isovolemic hemodilution are stable over time. Nine fentanyl-midazolam-anesthetized dogs were monitored to follow global cardiovascular and regional myocardial function. Isovolemic hemodilution was performed to a moderate (hemoglobin = 7.5 g%) target hemodilutional state that was maintained for 4 h. Data were obtained at each hemodilutional state and each hour during the 4-h period of sustained moderate hemodilution. During acute hemodilution, cardiac output increased from 2.6 +/- 0.5 L/min to 3.0 +/- 0.5 L/min (P < 0.05) and mean coronary flow increased from 20.8 +/- 2.4 mL/min to 31.4 +/- 5.5 mL/min (P < 0.05). Cardiac output and mean coronary flow remained elevated during the extended hemodilutional period. In addition, norepinephrine increased from 586 +/- 152 pg/mL to 1135 +/- 247 pg/mL (P < 0.05) during acute isovolemic hemodilution and remained at this increased level during extended hemodilution. Epinephrine levels did not change with hemodilution. Compensatory mechanisms such as increases in cardiac output and mean coronary flow observed during acute hemodilution persist during extended periods of hemodilution.
与等容血液稀释相关的心血管反应已有描述。然而，这些反应随时间的稳定性仍存在争议。我们假设等容血液稀释的血流动力学反应随时间是稳定的。对9只接受芬太尼 - 咪达唑仑麻醉的犬进行监测，以跟踪整体心血管和局部心肌功能。进行等容血液稀释至中度（血红蛋白 = 7.5 g%）目标血液稀释状态，并维持4小时。在每次血液稀释状态以及持续中度血液稀释的4小时期间的每小时获取数据。在急性血液稀释期间，心输出量从2.6±0.5升/分钟增加至3.0±0.5升/分钟（P < 0.05），平均冠状动脉血流量从20.8±2.4毫升/分钟增加至31.4±5.5毫升/分钟（P < 0.05）。在延长的血液稀释期内心输出量和平均冠状动脉血流量保持升高。此外，在急性等容血液稀释期间，去甲肾上腺素从586±152皮克/毫升增加至1135±247皮克/毫升（P < 0.05），并在延长的血液稀释期内维持在升高水平。肾上腺素水平随血液稀释无变化。在急性血液稀释期间观察到的心输出量和平均冠状动脉血流量增加等代偿机制在延长的血液稀释期内持续存在。
