Neubaur T E, Peters A, Schobel F C, Leschke M, Strauer B E
Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universitat Duesseldorf.
Z Kardiol. 1996 Jan;85(1):1-5.
Clinical and hemodynamic effects of isovolemic hemodilution (HD) were evaluated in 12 patients (aged 59 +/- 8 years) with severe multivessel coronary artery disease (CAD) and angina pectoris grade III (Canadian Cardiovascular Society classification) despite high-dose medical treatment. In none of these patients was aortocoronary bypass grafting or percutaneous transluminal coronary angioplasty possible. Prior to HD and after 3 months of HD the incidence of angina pectoris was determined by means of questionnaires; hemodynamic measurements were performed with right heart catheterization at rest and during exercise. After 3 months of HD hematocrit was reduced from 46.2 +/- 1.3% to 38.5 +/- 0.5%. The weekly incidence of angina pectoris was unchanged (19 +/- 7 before, 17 +/- 8 after HD). Cardiac index was 2.5 +/- 0.7 1/min/m2 at rest and 3.9 +/- 1.0 1/min/m2 during exercise before, 2.6 +/- 0.5 1/min/m2 at rest and 3.9 +/- 0.8 1/min/m2 during exercise after HD. Stroke volume index did not increase significantly neither at rest nor during exercise after HD. Initially, systemic vascular resistance decreased from 1659 +/- 603 to 1398 +/- 420 dyns/cm5 during exercise; after HD it was 1522 +/- 551 (rest) and 1283 +/- 348 dyns/cm5 (exercise). Mean pulmonary artery pressure (PAP) and wedge pressure (WP) were unchanged at rest (PAP: 19.9 +/- 6.7 mm Hg before, 19.2 +/- 6.5 mm Hg after HD; WP: 10.8 +/- 5.5 mm Hg before, 10.7 +/- 4.3 mm Hg after HD) and during exercise (PAP: 43.0 +/- 9.9 mm Hg before, 42.8 +/- 8.9 mm Hg after HD; WP: 30.8 +/- 4.6 mm Hg before, 30.6 +/- 6.5 mm Hg after HD). In conclusion, in patients with CAD isovolemic HD does not reduce angina pectoris but also does not induce clinical deterioration. Furthermore, isovolemic HD does not worsen the hemodynamic effects of severe CAD with impaired left ventricular function.
对12例（年龄59±8岁）患有严重多支冠状动脉疾病（CAD）且尽管接受大剂量药物治疗但心绞痛仍为Ⅲ级（加拿大心血管学会分级）的患者，评估了等容血液稀释（HD）的临床和血流动力学效应。这些患者均无法进行主动脉冠状动脉搭桥术或经皮腔内冠状动脉成形术。在HD前及HD 3个月后，通过问卷调查确定心绞痛的发生率；在静息和运动时用右心导管进行血流动力学测量。HD 3个月后，血细胞比容从46.2±1.3%降至38.5±0.5%。心绞痛的每周发生率未变（HD前19±7，HD后17±8）。HD前静息时心脏指数为2.5±0.7 l/min/m²，运动时为3.9±1.0 l/min/m²；HD后静息时为2.6±0.5 l/min/m²，运动时为3.9±0.8 l/min/m²。HD后静息和运动时每搏量指数均未显著增加。最初，运动时全身血管阻力从1659±603降至1398±420 dyns/cm⁵；HD后静息时为1522±551，运动时为1283±348 dyns/cm⁵。平均肺动脉压（PAP）和楔压（WP）在静息时（PAP：HD前19.9±6.7 mmHg，HD后19.2±6.5 mmHg；WP：HD前10.8±5.5 mmHg，HD后10.7±4.3 mmHg）和运动时（PAP：HD前43.0±9.9 mmHg，HD后42.8±8.9 mmHg；WP：HD前30.8±4.6 mmHg，HD后30.6±6.5 mmHg）均未改变。总之，对于CAD患者，等容HD既不能减轻心绞痛，也不会导致临床恶化。此外，等容HD不会使左心室功能受损的严重CAD的血流动力学效应恶化。
