不同程度急性等容性血液稀对家兔血清S-100B蛋白浓度及脑氧代谢的影响
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摘要
目的观察不同程度急性等容性血液稀释对常温条件下家兔血清S-100B蛋白浓度及脑氧代谢的影响。
方法24只成年家兔,随机分为4组,对照组(A组)不进行血液稀释,其余三组的目标HCT分别为24%(B组)、18%(C组)、12%(D组)。以20%乌拉坦行耳缘静脉麻醉后机械通气,并维持体温在37oC。分离左颈动、静脉、右颈内静脉、左股动、静脉并置管以监测血流动力学、血液标本采集及进行血液稀释。分别在血液稀释后的2小时(T1)、4小时(T2)、8小时(T3)检测颈动、静脉血气,并根据FICKS公式计算出脑氧代谢率CERO2。各时点血清样本均离心,取上清液,-20℃低温保存,以ELISA法检测血清S-100B蛋白浓度。ANH后8小时后处死动物,取右侧脑组织,称量干、湿重,计算脑组织含水量。
结果B组血清S-100B蛋白浓度及PHjv、CERO2与A组相比无明显差异(P>0.05);C组血清S-100B蛋白浓度、CERO2在血液稀释后8小时(T3)较基础值(T0)增高,PHjv明显降低(P<0.05);而D组血清S-100B蛋白浓度、CERO2在血液稀释后2小时(T1)即较基础值(T0)明显增高,PHjv明显降低(P<0.05),后两个时点(T2、T3)此种趋势更为明显(P<0.05)。各组脑含水量无明显差异(P>0.05)
结论急性等容性血液稀释目标HCT为24%时,对常温条件下家兔脑氧代谢并无影响;目标HCT为18%时,在血液稀释后8小时后出现脑氧代谢失衡及脑组织损伤的表现;目标HCT为12%的急性血液稀释无法满足常温条件下脑氧代谢需求,并出现缺氧性脑组织损伤的表现。
Objective To investigate the effect of different degree acute normovolemic hemodilution with 6% HES on the serum level of S-100B proteinum and cerebral oxygen metabolism under common temperature in rabbits.
Methods Twenty-four major rabbits were randomly assigned to four groups (n=6): Group A was control group; HCT in Group B, C and D were targeted with 24%, 18% and 12% respectively. All animals were anaesthetized with intravenous 20% ethyl carbamate 5ml.kg-1 and mechanically ventilated(Vt =15ml kg-1, f=30 bpm) with body temperature maintained on 37oC. Left jugular artery and vein were cannulated for BP, blood gas analysis and blood sample collection, Right jugular vein was for CVP monitoring, Left femoral artery and vein were cannulated for hemodilution. Blood withdrawn from femoral artery was simultaneously replaced by intravenous infusion of equal volume of 6% HES until achieving targeted HCT. Blood gas, CERO2 and serum levels of S-100B proteinum were analyzed at 2 hours, 4 hours and 8 hours after hemodilution. Brain water content was examined using the“dry-wet weighing technique”.
Results There were no obvious difference in the serum level of S-100B proteinum, CERO2 and PHjv between Group A and B (P>0.05). Levels of S-100B proteinum and CERO2 raised while PHjv decreased significantly at 8 hours after hemodilution in group C (P<0.05); In group D, the levels of S-100B proteinum and CERO2 stepped up from 2 hours (T1) to 8 hours (T3) after hemodilution with lower PHjv (P<0.05). There were no significant difference in brain water content between all groups (P>0.05).
Conclusion When targeted HCT with 24%, ANH do not disturb cerebral oxygen metabolism. If the targeted HCT is 18%, ANH can disturb cerebral oxygen metabolism at 8 hours after hemodilution. When the hemodilution for 12% target HCT is performed, all of the compensation mechanism can not sustain cerebral oxygen metabolism on common temperature and brain will be impaired.
方法24只成年家兔,随机分为4组,对照组(A组)不进行血液稀释,其余三组的目标HCT分别为24%(B组)、18%(C组)、12%(D组)。以20%乌拉坦行耳缘静脉麻醉后机械通气,并维持体温在37oC。分离左颈动、静脉、右颈内静脉、左股动、静脉并置管以监测血流动力学、血液标本采集及进行血液稀释。分别在血液稀释后的2小时(T1)、4小时(T2)、8小时(T3)检测颈动、静脉血气,并根据FICKS公式计算出脑氧代谢率CERO2。各时点血清样本均离心,取上清液,-20℃低温保存,以ELISA法检测血清S-100B蛋白浓度。ANH后8小时后处死动物,取右侧脑组织,称量干、湿重,计算脑组织含水量。
结果B组血清S-100B蛋白浓度及PHjv、CERO2与A组相比无明显差异(P>0.05);C组血清S-100B蛋白浓度、CERO2在血液稀释后8小时(T3)较基础值(T0)增高,PHjv明显降低(P<0.05);而D组血清S-100B蛋白浓度、CERO2在血液稀释后2小时(T1)即较基础值(T0)明显增高,PHjv明显降低(P<0.05),后两个时点(T2、T3)此种趋势更为明显(P<0.05)。各组脑含水量无明显差异(P>0.05)
结论急性等容性血液稀释目标HCT为24%时,对常温条件下家兔脑氧代谢并无影响;目标HCT为18%时,在血液稀释后8小时后出现脑氧代谢失衡及脑组织损伤的表现;目标HCT为12%的急性血液稀释无法满足常温条件下脑氧代谢需求,并出现缺氧性脑组织损伤的表现。
Objective To investigate the effect of different degree acute normovolemic hemodilution with 6% HES on the serum level of S-100B proteinum and cerebral oxygen metabolism under common temperature in rabbits.
Methods Twenty-four major rabbits were randomly assigned to four groups (n=6): Group A was control group; HCT in Group B, C and D were targeted with 24%, 18% and 12% respectively. All animals were anaesthetized with intravenous 20% ethyl carbamate 5ml.kg-1 and mechanically ventilated(Vt =15ml kg-1, f=30 bpm) with body temperature maintained on 37oC. Left jugular artery and vein were cannulated for BP, blood gas analysis and blood sample collection, Right jugular vein was for CVP monitoring, Left femoral artery and vein were cannulated for hemodilution. Blood withdrawn from femoral artery was simultaneously replaced by intravenous infusion of equal volume of 6% HES until achieving targeted HCT. Blood gas, CERO2 and serum levels of S-100B proteinum were analyzed at 2 hours, 4 hours and 8 hours after hemodilution. Brain water content was examined using the“dry-wet weighing technique”.
Results There were no obvious difference in the serum level of S-100B proteinum, CERO2 and PHjv between Group A and B (P>0.05). Levels of S-100B proteinum and CERO2 raised while PHjv decreased significantly at 8 hours after hemodilution in group C (P<0.05); In group D, the levels of S-100B proteinum and CERO2 stepped up from 2 hours (T1) to 8 hours (T3) after hemodilution with lower PHjv (P<0.05). There were no significant difference in brain water content between all groups (P>0.05).
Conclusion When targeted HCT with 24%, ANH do not disturb cerebral oxygen metabolism. If the targeted HCT is 18%, ANH can disturb cerebral oxygen metabolism at 8 hours after hemodilution. When the hemodilution for 12% target HCT is performed, all of the compensation mechanism can not sustain cerebral oxygen metabolism on common temperature and brain will be impaired.
引文
[1] Fearn SJ, Pole R, Wesnes K, Faragher EB, et al. Cerebral injury during cardiopulmonary bypass: emboli impair memory.[J]. Thorac Cardiovasc Surg , 2001, Jun,121(6):1150-60.
[2] Ickx BE, Rigolet M, Van Der Linden P. Cardiovascular and metabolic response to acute normovolemic anemia.Effects of anesthesia.[J]. Anesthesiology,2000 Oct,93(4):1011-6.
[3] De Jonge E, Levi M. Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med. 2001 Jun;29(6):1261-7. Review.
[4] DeFoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group.[J] Ann Thorac Surg.,2001, Mar,71(3):769-76.
[5] Sungurtekin H, Cook DJ, Orszulak TA, et al .Cerebral response to hemodilution during hypothermic cardiopulmonary bypass in adults.[J]. Anesth Analg, 1999 Nov,89(5):1078-83.
[6] Florio P,Michetti F,Bruschettini M,et a1.Amniotic fluid S100B protein in mid-gestation and intrauterine fetal death.[J] .Lancet,2004,364(9430):270-272.
[7] 杨辉,王鹏,田玉科等 6%羟乙基淀粉深度血液稀释对家兔凝血曲线的影响中华麻醉学杂志,2003,23(4):291
[8] Van der Linden P, De Hert S, Mathieu N, et al.[J]Anesthesiology. 2003 ,Jul,99(1):97-104.
[9] Homi HM, Yang H, Pearlstein RD, et al. Hemodilution during cardiopulmonary bypass increases cerebral infarct volume after middle cerebral artery occlusion in rats.[J]Anesth Analg. 2004 Oct;99(4):974-81.
[10] Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice bechanged? [J]Thorac Cardiovasc Surg, 2003, Jun,125(6):1438-50.
[11] Innerhofer P, Fries D, Margreiter J,et al. The effects of perioperatively administered colloids and crystalloids on primary platelet-mediated hemostasis and clot formation. [J]Anesth Analg,2002 Oct,95(4):858-65.
[12] Weiskopf RB, Viele MK, Feiner J, et al.Human cardiovascular and metabolic response to acute, severe isovolemic anemia [J].JAMA,1998, Jan 21;279(3):217-21.
[13] Lieberman JA, Weiskopf RB, Kelley SD, et al.Critical oxygen delivery in conscious humans is less than 7.3 mL O2. kg-1. min-1. [J]Anesthesiology, 2000, Feb,92(2):407-13.
[14] Sekaran P, Ehrlich MP, Hagl C, et al. A comparison of complete blood replacement with varying hematocrit levels on neurological recovery in a porcine model of profound hypothermic (<5 degrees C) circulatory arrest.[J] Anesth Analg,2001 Feb,92(2):329-34
[15] Chieregato A,Calzolari F,Trasforini G,et a1.Normal jugular bulb oxygen saturation.[J] Neurol Neurosurg Psychiatry,2003,74:784-785.
[16] Larsson A, Lipcsey M, Sjolin J,et al Slight increase of serum S-100B during porcine endotoxemic shock may indicate blood-brain barrier damage. [J]Anesth Analg. 2005 Nov;101(5):1465-9.
[17] Buyukuysal RL, Protein S100B release from rat brain slices during and after ischemia: comparison with lactate dehydrogenase leakage.[J]Neurochem Int. 2005 Dec;47(8):580-8. Epub 2005 Sep 27.
[18] Tu YK, Liu HM. Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity.[J] Stroke,1996 ,Mar;27(3):441-5.
[19] Van der Linden P, De Hert S, et al . Tolerance to acute isovolemic hemodilution. Effect of anesthetic depth. [J].Anesthesiology,2003 ,Jul,99(1):97-104.
[20] Perez-Trepichio AD, Furlan AJ, Little JR, et a1. Hydroxyethyl starch 200/0.5 reduces infarct volume after embolic stroke in rats. [J].Stroke. 1992 Dec;23(12):1782-90
[21] Kaplan SS,ParkTS,Gonzales ER,et a1.Hydroxyethyl starch reduces leukocyte adherence and vascular injury in the newborn pig cerebral circulation after asphyxia..[J].Stroke,2000,Sep;31(9):2218-23
[1] Ickx BE, Rigolet M, Van Der Linden P. Cardiovascular and metabolic response to acute normovolemic anemia. Effects of anesthesia.[J]. Anesthesiology,2000 Oct,93(4):1011-6.
[2] Tu YK, Liu HM. Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity.[J] Stroke,1996 ,Mar;27(3):441-5.
[3] Fearn SJ, Pole R, Wesnes K, Faragher EB, et al. Cerebral injury duringcardiopulmonary bypass: emboli impair memory.[J]. Thorac Cardiovasc Surg , 2001, Jun,121(6):1150-60.
[4] Van der Linden P, De Hert S, et al . Tolerance to acute isovolemic hemodilution. Effect of anesthetic depth [M].Anesthesiology,2003 ,Jul,99(1):97-104.
[5] Homi HM, Yang H, Pearlstein RD, et al. Hemodilution during cardiopulmonary bypass increases cerebral infarct volume after middle cerebral artery occlusion in rats.[J]. Anesth Analg,2004 Oct;99(4):974-81.
[6] Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult:should current practice be changed?[J]. Thorac Cardiovasc Surg, 2003, Jun,125(6):1438-50.
[7] DeFoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. [J]. Ann Thorac Surg,2001, Mar,71(3):769-76.
[8] Sungurtekin H, Cook DJ, Orszulak TA, et al .Cerebral response to hemodilution during hypothermic cardiopulmonary bypass in adults.[J]. Anesth Analg, 1999 Nov,89(5):1078-83.
[9] Weiskopf RB, Viele MK, Feiner J, et al: Human cardiovascular and metabolic response to acute, severe isovolemic anemia.[J].JAMA,1998,Jan 21;279(3):217-21.
[10] Lieberman JA, Weiskopf RB, Kelley SD, et al.Critical oxygen delivery in conscious humans is less than 7.3 mL O2. kg-1. min-1. [J].Anesthesiology, 2000, Feb,92(2):407-13.
[2] Ickx BE, Rigolet M, Van Der Linden P. Cardiovascular and metabolic response to acute normovolemic anemia.Effects of anesthesia.[J]. Anesthesiology,2000 Oct,93(4):1011-6.
[3] De Jonge E, Levi M. Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med. 2001 Jun;29(6):1261-7. Review.
[4] DeFoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group.[J] Ann Thorac Surg.,2001, Mar,71(3):769-76.
[5] Sungurtekin H, Cook DJ, Orszulak TA, et al .Cerebral response to hemodilution during hypothermic cardiopulmonary bypass in adults.[J]. Anesth Analg, 1999 Nov,89(5):1078-83.
[6] Florio P,Michetti F,Bruschettini M,et a1.Amniotic fluid S100B protein in mid-gestation and intrauterine fetal death.[J] .Lancet,2004,364(9430):270-272.
[7] 杨辉,王鹏,田玉科等 6%羟乙基淀粉深度血液稀释对家兔凝血曲线的影响中华麻醉学杂志,2003,23(4):291
[8] Van der Linden P, De Hert S, Mathieu N, et al.[J]Anesthesiology. 2003 ,Jul,99(1):97-104.
[9] Homi HM, Yang H, Pearlstein RD, et al. Hemodilution during cardiopulmonary bypass increases cerebral infarct volume after middle cerebral artery occlusion in rats.[J]Anesth Analg. 2004 Oct;99(4):974-81.
[10] Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice bechanged? [J]Thorac Cardiovasc Surg, 2003, Jun,125(6):1438-50.
[11] Innerhofer P, Fries D, Margreiter J,et al. The effects of perioperatively administered colloids and crystalloids on primary platelet-mediated hemostasis and clot formation. [J]Anesth Analg,2002 Oct,95(4):858-65.
[12] Weiskopf RB, Viele MK, Feiner J, et al.Human cardiovascular and metabolic response to acute, severe isovolemic anemia [J].JAMA,1998, Jan 21;279(3):217-21.
[13] Lieberman JA, Weiskopf RB, Kelley SD, et al.Critical oxygen delivery in conscious humans is less than 7.3 mL O2. kg-1. min-1. [J]Anesthesiology, 2000, Feb,92(2):407-13.
[14] Sekaran P, Ehrlich MP, Hagl C, et al. A comparison of complete blood replacement with varying hematocrit levels on neurological recovery in a porcine model of profound hypothermic (<5 degrees C) circulatory arrest.[J] Anesth Analg,2001 Feb,92(2):329-34
[15] Chieregato A,Calzolari F,Trasforini G,et a1.Normal jugular bulb oxygen saturation.[J] Neurol Neurosurg Psychiatry,2003,74:784-785.
[16] Larsson A, Lipcsey M, Sjolin J,et al Slight increase of serum S-100B during porcine endotoxemic shock may indicate blood-brain barrier damage. [J]Anesth Analg. 2005 Nov;101(5):1465-9.
[17] Buyukuysal RL, Protein S100B release from rat brain slices during and after ischemia: comparison with lactate dehydrogenase leakage.[J]Neurochem Int. 2005 Dec;47(8):580-8. Epub 2005 Sep 27.
[18] Tu YK, Liu HM. Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity.[J] Stroke,1996 ,Mar;27(3):441-5.
[19] Van der Linden P, De Hert S, et al . Tolerance to acute isovolemic hemodilution. Effect of anesthetic depth. [J].Anesthesiology,2003 ,Jul,99(1):97-104.
[20] Perez-Trepichio AD, Furlan AJ, Little JR, et a1. Hydroxyethyl starch 200/0.5 reduces infarct volume after embolic stroke in rats. [J].Stroke. 1992 Dec;23(12):1782-90
[21] Kaplan SS,ParkTS,Gonzales ER,et a1.Hydroxyethyl starch reduces leukocyte adherence and vascular injury in the newborn pig cerebral circulation after asphyxia..[J].Stroke,2000,Sep;31(9):2218-23
[1] Ickx BE, Rigolet M, Van Der Linden P. Cardiovascular and metabolic response to acute normovolemic anemia. Effects of anesthesia.[J]. Anesthesiology,2000 Oct,93(4):1011-6.
[2] Tu YK, Liu HM. Effects of isovolemic hemodilution on hemodynamics, cerebral perfusion, and cerebral vascular reactivity.[J] Stroke,1996 ,Mar;27(3):441-5.
[3] Fearn SJ, Pole R, Wesnes K, Faragher EB, et al. Cerebral injury duringcardiopulmonary bypass: emboli impair memory.[J]. Thorac Cardiovasc Surg , 2001, Jun,121(6):1150-60.
[4] Van der Linden P, De Hert S, et al . Tolerance to acute isovolemic hemodilution. Effect of anesthetic depth [M].Anesthesiology,2003 ,Jul,99(1):97-104.
[5] Homi HM, Yang H, Pearlstein RD, et al. Hemodilution during cardiopulmonary bypass increases cerebral infarct volume after middle cerebral artery occlusion in rats.[J]. Anesth Analg,2004 Oct;99(4):974-81.
[6] Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult:should current practice be changed?[J]. Thorac Cardiovasc Surg, 2003, Jun,125(6):1438-50.
[7] DeFoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. [J]. Ann Thorac Surg,2001, Mar,71(3):769-76.
[8] Sungurtekin H, Cook DJ, Orszulak TA, et al .Cerebral response to hemodilution during hypothermic cardiopulmonary bypass in adults.[J]. Anesth Analg, 1999 Nov,89(5):1078-83.
[9] Weiskopf RB, Viele MK, Feiner J, et al: Human cardiovascular and metabolic response to acute, severe isovolemic anemia.[J].JAMA,1998,Jan 21;279(3):217-21.
[10] Lieberman JA, Weiskopf RB, Kelley SD, et al.Critical oxygen delivery in conscious humans is less than 7.3 mL O2. kg-1. min-1. [J].Anesthesiology, 2000, Feb,92(2):407-13.