急性等容血液稀释对兔小肠氧代谢的影响
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摘要
目的：观察急性等容血液稀释(ANH)对家兔小肠氧代谢的影响，探讨小肠氧代谢失衡时血液稀释的极限程度，全身与小肠氧代谢的平衡状况。方法：选择成年健康家兔28只，随机分为4组，每组7只，即中度血液稀释组(H1组)，重度血液稀释组(H2组)，极度血液稀释组(H3组)，对照组(H0组)。在稀释前(T1)、稀释后(T2)两个时点同步抽肠系膜上动脉、肠系膜上静脉、股动脉和颈内静脉血样本，进行血气分析,并测定股动脉血乳酸盐含量(ABL)和肠系膜上静脉、颈内静脉血乳酸盐含量(VBL)，计算全身及小肠的动脉血氧含量 (CaO2)、静脉血氧含量(CvO2)、氧摄取率(ERO2)、静脉-动脉乳酸含量差（VADL）等参数。结果：各稀释组家兔稀释前所有指标与H0组比较均无显著性差异。各组家兔MAP在稀释前后无变化，稀释后重度和极度稀释组HR增快(P <0.01)。在血液稀释后H1、H2、H3组Hct降为24.33%±2.48%、14.97%±2.11%、9.59%±0.56%，达到中度、重度、极度血液稀释水平；全身和小肠的CaO2和CvO2降低。血液稀释后全身和小肠的ERO2升高， H2、H3组与H0组比较有
显著性差异(P<0.01)。在血液稀释后全身ABL、全身和小肠的VBL和VADL升高，H3组与H0组比较有显著性差异(P<0.01)。各组内同一时点全身与小肠所有指标相比均无显著性差异。结论：中度ANH不影响小肠氧代谢；重度ANH时小肠ERO2升高，仍在代偿范围内；极度ANH小肠氧供需失衡，出现无氧代谢。全身与小肠氧代谢平衡趋势一致。
【Objective】To observe the effects of acute normovolemic hemodilution(ANH) on intestinal oxygen metabolism in anesthetized rabbits ,and investigate the limits of ANH that result in intestinal anaerobic metabolism. To study the tendence of intestinal and systemic oxygen metabolism.【Methods】 Twenty-eight rabbits were divided into three hemodilution groups( H1, H2 and H3 groups) and one control group (H0 group) randomly. The different degree of ANH ,namely moderate( H1 ,Hct = 24.33%) ,severe ( H2, Hct = 14.97%) and extreme(H3 ,Hct =9.59% ),were accomplished by exchanging whole blood with 4% Gelofusion. Superior mesenteric arterial and superior mesenteric venous blood gas, femoral arterial and internal jugular venous blood gas, femoral arterial blood lactate value(ABL), superior mesenteric venous and internal jugular venous blood lactate value (VBL) ,were measured prior to hemodilution and 1 hour after hemodilution . Diference of oxygen content , oxygen extraction ratio(ERO2) and venous-arterial difference of lactate (VADL) were calculated. 【Results】Mean arterial pressure of all rabbits were stable, and heart rate increased
after ANH in H2 and H3 groups. As compared with H0 group,both intestinal and systemic CaO2 ,CvO2 decreased significantly after ANH in H1,H2 and H3 groups. There was a significant(P<0.01) increase in ERO2 after ANH in H2 and H3 groups; whereas no significant difference was found in H1 group. ABL ,VBL and VADL increased significantly after ANH in H3 group; and no change was found in H1 and H2 groups. Compared to what was measured before ANH, the tendency was the same as that comparing with H0, besides ERO2 was higher in H1 group .No significant difference was found between all groups before ANH .All of intestinal and systemic mesurements in the same group had no difference. 【Conclusions】 This study suggests that moderate ANH do not affect intestinal oxygen metabolism; severe ANH change intestinal oxygen metabolism,but can be compensated; extreme ANH result in intestinal anaerobic metabolism. Systemic and intestinal oxygen metabolisms are changed at the same ANH degree.
显著性差异(P<0.01)。在血液稀释后全身ABL、全身和小肠的VBL和VADL升高，H3组与H0组比较有显著性差异(P<0.01)。各组内同一时点全身与小肠所有指标相比均无显著性差异。结论：中度ANH不影响小肠氧代谢；重度ANH时小肠ERO2升高，仍在代偿范围内；极度ANH小肠氧供需失衡，出现无氧代谢。全身与小肠氧代谢平衡趋势一致。
【Objective】To observe the effects of acute normovolemic hemodilution(ANH) on intestinal oxygen metabolism in anesthetized rabbits ,and investigate the limits of ANH that result in intestinal anaerobic metabolism. To study the tendence of intestinal and systemic oxygen metabolism.【Methods】 Twenty-eight rabbits were divided into three hemodilution groups( H1, H2 and H3 groups) and one control group (H0 group) randomly. The different degree of ANH ,namely moderate( H1 ,Hct = 24.33%) ,severe ( H2, Hct = 14.97%) and extreme(H3 ,Hct =9.59% ),were accomplished by exchanging whole blood with 4% Gelofusion. Superior mesenteric arterial and superior mesenteric venous blood gas, femoral arterial and internal jugular venous blood gas, femoral arterial blood lactate value(ABL), superior mesenteric venous and internal jugular venous blood lactate value (VBL) ,were measured prior to hemodilution and 1 hour after hemodilution . Diference of oxygen content , oxygen extraction ratio(ERO2) and venous-arterial difference of lactate (VADL) were calculated. 【Results】Mean arterial pressure of all rabbits were stable, and heart rate increased
after ANH in H2 and H3 groups. As compared with H0 group,both intestinal and systemic CaO2 ,CvO2 decreased significantly after ANH in H1,H2 and H3 groups. There was a significant(P<0.01) increase in ERO2 after ANH in H2 and H3 groups; whereas no significant difference was found in H1 group. ABL ,VBL and VADL increased significantly after ANH in H3 group; and no change was found in H1 and H2 groups. Compared to what was measured before ANH, the tendency was the same as that comparing with H0, besides ERO2 was higher in H1 group .No significant difference was found between all groups before ANH .All of intestinal and systemic mesurements in the same group had no difference. 【Conclusions】 This study suggests that moderate ANH do not affect intestinal oxygen metabolism; severe ANH change intestinal oxygen metabolism,but can be compensated; extreme ANH result in intestinal anaerobic metabolism. Systemic and intestinal oxygen metabolisms are changed at the same ANH degree.
引文
1 Hjelmqvist B,Tedera H,Borgstrom A,et al.Indom ethacin and pancreatic blood flow.Acta Chir Scand,1990,156:543-547.
2 Dahn MS,Lange MP,Jacobs LA.Central mixed and splanchnic venous oxygen saturation monitoring.Intensive Care Med,1988,14:373-378.
3 Gillon J, Thomas J, Desmond J.Acute normovolaemic hemodiultion.Transfusion , 1996,36:640-643.
4 Monk G, Goodnough L, BirkmeyerJ, et al. Acute normovolemic hemodilution is a cost effective alternative to preoperative autologous blood onation by patients undergoing radical retropubic prostatctomy. Transfusion,1995,35:559-565.
5 Fontana J,Welborn L,Monganp D,et al.Oxygen comsumption and cardiovascular function in children during profound intraoperative normovolemic hemodilution. Anesth Analg,1995,80:219-225.
6 Kreimeier U,Messmer K.Hemodilution in clinical surgery:state of the art 1996, World J Surg,1996,20:1208-1217.
7 Swank GM,Deitch EA. Role of the gut in multiple organ failure:bacterial translocation and permeability changes. Word J Surg, 1996,20:411-417.
8 Wilmore DW,Smith RJ,Odwyer ST.The gut: a central organ after surgical stress. Surgery ,1988,104:917-923.
9 Stehling L, Zauder HL.Acute normovolemic hemodilution. Transfusion ,1991,31:857.
10 Zuck TF, Jean GR.Current states of injectable oxygen car riers. Crit Revi Clini Lab Sci,1994,31:295.
11 Wagner PD.Limitation of oxygen transport to the cell. Intensive Care Med, 1995,21:397-402.
12 LeungJM,Weiskopf RB, Feiner J,et al. Electrocardiographic ST-segment change during acute severe isovolemic hemodilution in humans.Anesthesiology,2000,93:1004-1010.
13 王清秀，靳凤玲，李钊，等.急性等容血液稀释对组织氧供氧耗的影响.中华麻醉学杂志，1997，17：272-275.
14 Schaller RT,Schaller J,Furmen EB.Hemodilution anesthesia: a valuable aid to major cancer surgery in chindren.Am J Surg,1983,146:79-84.
15 Kleen M, Habler O, Hutter J, Podtschaske A, et al. Effects of hemodilution on splanchnic perfusion and hepatorenal function. I. Splanchnic perfusion. Eur J Med Res ,1997 ,30:413-418.
16 Fukusaki M ,Nakamura T, Miyoshi H,et al. Splanchnic perfusion during controlled hypotension combined with acute hypervolemic hemodilution: a comparison with combination of acute normovolemic hemodilution gastric intramucosal pH study. J Clin Anesth,2000,12:421-426.
17 Noldge GF, Priebe HJ, Bohle W, et al. Effects of acute normovolemic hemodilution on splanchnic oxygenation and on hepatic histology and metabolism in anesthetized pigs Anesth,1991,74:908-918.
18 Nielsen VG, Baird MS . Extreme hemodilution in rabbits: an in vitro and in vivo Thrombelastographic analysis. Anesth Analg, 2000,90:541.
19 Nielsen VG, Baird MS, Brix AE, et al. Extreme, progressive isovolemic hemodilution with 5% human albumin, PentaLyte, or Hextend does not cause hepatic ischemia or histologic injury in rabbits.Anesth,1999,90:1428.
20 Secchi A, Orlanderl JM, Schmidt W, et al. Effect of endotoxemia on hepatic portal and sinusoidal blood flow in rats. J Surg Res, 2000,89:26-30.
21 邓硕曾.血液保护与血液麻醉.《国外医学》麻醉学与复苏分册，2000，21：119-122.
22 Sauaia A, Moore EE. Early risk factors for postinjury multiple organ failure. World J Surg, 1996,20:392-400 .
23 Gennari R, Alexander JM. Effects of hyperoxia on bacteria translocation and mortality during gut-derived-sepsis. Arch Surg,1996,131:57-62.
24 Lckx BE,Rigolet M,Van Der Linden PJ.Cardiovascular and metabolic response to acute normovolemic anemia:effects of anesthesia.Anesthesiology,2000,93:1011-1016.
25 Mythen MG, Webb AR. The role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. Intensive Care Med. 1994,20:203-209.
2 Dahn MS,Lange MP,Jacobs LA.Central mixed and splanchnic venous oxygen saturation monitoring.Intensive Care Med,1988,14:373-378.
3 Gillon J, Thomas J, Desmond J.Acute normovolaemic hemodiultion.Transfusion , 1996,36:640-643.
4 Monk G, Goodnough L, BirkmeyerJ, et al. Acute normovolemic hemodilution is a cost effective alternative to preoperative autologous blood onation by patients undergoing radical retropubic prostatctomy. Transfusion,1995,35:559-565.
5 Fontana J,Welborn L,Monganp D,et al.Oxygen comsumption and cardiovascular function in children during profound intraoperative normovolemic hemodilution. Anesth Analg,1995,80:219-225.
6 Kreimeier U,Messmer K.Hemodilution in clinical surgery:state of the art 1996, World J Surg,1996,20:1208-1217.
7 Swank GM,Deitch EA. Role of the gut in multiple organ failure:bacterial translocation and permeability changes. Word J Surg, 1996,20:411-417.
8 Wilmore DW,Smith RJ,Odwyer ST.The gut: a central organ after surgical stress. Surgery ,1988,104:917-923.
9 Stehling L, Zauder HL.Acute normovolemic hemodilution. Transfusion ,1991,31:857.
10 Zuck TF, Jean GR.Current states of injectable oxygen car riers. Crit Revi Clini Lab Sci,1994,31:295.
11 Wagner PD.Limitation of oxygen transport to the cell. Intensive Care Med, 1995,21:397-402.
12 LeungJM,Weiskopf RB, Feiner J,et al. Electrocardiographic ST-segment change during acute severe isovolemic hemodilution in humans.Anesthesiology,2000,93:1004-1010.
13 王清秀，靳凤玲，李钊，等.急性等容血液稀释对组织氧供氧耗的影响.中华麻醉学杂志，1997，17：272-275.
14 Schaller RT,Schaller J,Furmen EB.Hemodilution anesthesia: a valuable aid to major cancer surgery in chindren.Am J Surg,1983,146:79-84.
15 Kleen M, Habler O, Hutter J, Podtschaske A, et al. Effects of hemodilution on splanchnic perfusion and hepatorenal function. I. Splanchnic perfusion. Eur J Med Res ,1997 ,30:413-418.
16 Fukusaki M ,Nakamura T, Miyoshi H,et al. Splanchnic perfusion during controlled hypotension combined with acute hypervolemic hemodilution: a comparison with combination of acute normovolemic hemodilution gastric intramucosal pH study. J Clin Anesth,2000,12:421-426.
17 Noldge GF, Priebe HJ, Bohle W, et al. Effects of acute normovolemic hemodilution on splanchnic oxygenation and on hepatic histology and metabolism in anesthetized pigs Anesth,1991,74:908-918.
18 Nielsen VG, Baird MS . Extreme hemodilution in rabbits: an in vitro and in vivo Thrombelastographic analysis. Anesth Analg, 2000,90:541.
19 Nielsen VG, Baird MS, Brix AE, et al. Extreme, progressive isovolemic hemodilution with 5% human albumin, PentaLyte, or Hextend does not cause hepatic ischemia or histologic injury in rabbits.Anesth,1999,90:1428.
20 Secchi A, Orlanderl JM, Schmidt W, et al. Effect of endotoxemia on hepatic portal and sinusoidal blood flow in rats. J Surg Res, 2000,89:26-30.
21 邓硕曾.血液保护与血液麻醉.《国外医学》麻醉学与复苏分册，2000，21：119-122.
22 Sauaia A, Moore EE. Early risk factors for postinjury multiple organ failure. World J Surg, 1996,20:392-400 .
23 Gennari R, Alexander JM. Effects of hyperoxia on bacteria translocation and mortality during gut-derived-sepsis. Arch Surg,1996,131:57-62.
24 Lckx BE,Rigolet M,Van Der Linden PJ.Cardiovascular and metabolic response to acute normovolemic anemia:effects of anesthesia.Anesthesiology,2000,93:1011-1016.
25 Mythen MG, Webb AR. The role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. Intensive Care Med. 1994,20:203-209.