Nonlinear cardiovascular regulation consequent to changes in blood viscosity
Nonlinear cardiovascular regulation consequent to changes in blood viscosity
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DOI：
10.3233/ch-2011-1454
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发表时间：
2011-01-01
影响因子：
2.1
通讯作者：
Intaglietta, Marcos
中科院分区：
文献类型：
--
作者：
Salazar Vazquez, Beatriz Y.;Cabrales, Pedro;Intaglietta, Marcos
血液和血浆粘度增加通常与病理状况和心血管风险增加有关，这种看法部分基于血液粘度增加到血液浓缩达到的极值的研究。目前的研究得到人类流行病学研究的支持，表明适度增加Hct可改善心血管功能，反之亦然。这一结果是由于周围血管阻力的非线性调节，这是由于血液粘度增加导致血管壁上的剪切应力增加，导致一氧化氮产生增加而引起的。当血浆粘度在极度血液稀释循环中增加时，发现了类似的效果。在这两种情况下，在小动脉/毛细血管水平上都有影响，导致微血管功能改善和超灌注，促进代谢废物的清除，同时保持氧气输送。将这些发现应用于粘胶血浆扩张器的设计，提出了一种治疗出血的新方法，它在一定程度上取代了输血的使用，使输血触发率降低到低于通常认为的安全水平成为可能。
Increasing blood and plasma viscosity is generally associated with pathological conditions, and increased cardiovascular risk, a perception based in part on studies where blood viscosity is increased to extreme values attained by hemoconcentration. Present studies, supported by epidemiological studies in humans, show that moderate increases in Hct improve cardiovascular function and vice versa. This result is due to the nonlinear regulation of peripheral vascular resistance arising from the increased production of nitric oxide following the increase of shear stress on the vascular wall due to increasing blood viscosity. Similar effects are found in when plasma viscosity is increased in the extremely hemodiluted circulation. In both cases there is an effect at the arteriolar/capillary level, leading to a condition of improved microvascular function and supra perfusion that facilitates clearance of metabolic waste products, while maintaining oxygen delivery. Application of these findings to the design of viscogenic plasma expanders suggests a new approach for the treatment of hemorrhage that in part replaces the use of blood transfusions, making it feasible to lower the transfusion trigger to levels below than normally considered safe.