Regional Hemodynamics and Oxygen Supply During Isovolemic Hemodilution Alone and in Combination with Adenosine‐Induced Controlled Hypotension
Regional Hemodynamics and Oxygen Supply During Isovolemic Hemodilution Alone and in Combination with Adenosine‐Induced Controlled Hypotension
复制标题
单独等容血液稀释和与腺苷诱导的控制性低血压相结合期间的局部血流动力学和供氧
作者：
G. J. Crystal;M. Rooney;M. Salem
在10只戊巴比妥麻醉开胸犬中进行了研究，以评价等容血液稀释单独和与腺苷诱导的控制性降压联合使用的局部循环效应。用15 μm放射性微球测量局部血流量，计算局部氧供应量。5%右旋糖酐血液稀释（40，000分子量）使动脉血细胞比容和氧含量减少约一半，并引起局部血流量的不均匀变化;脾脏血流量减少，肾皮质、肝脏、骨骼肌和皮肤血流量不变，十二指肠、胰腺、大脑和心肌血流量增加;然而，只有脑和心肌的血流增加足以维持氧供应。静脉输注腺苷可使主动脉压降低50%，并减少大部分组织（肾皮质、胰腺、肝脏、脾脏、皮肤和大脑）的血流，结果导致这些器官产生或加重缺氧。肾皮质（-73%）和大脑皮质（-37%）的血流减少幅度值得注意。在心肌梗死中，腺苷直接扩张冠状血管导致血流量和氧供应平行增加，超过了主要的代谢要求。得出的结论是：1）在单独等容血液稀释期间，维持对大脑和心肌的氧气供应，以牺牲对不太重要器官的氧气供应为代价; 2）在联合等容血液稀释和腺苷诱导的低血压期间，对心肌的氧气供应过多，但对大脑和肾脏的氧气供应不足。后一种效应表明，需要对使用等容血液稀释和腺苷诱导性低血压联合治疗的患者进行广泛的临床监测。
Studies were performed in ten pentobarbital-anesthetized, open chest dogs to evaluate regional circulatory effects of isovolemic hemodilution alone, and in combination with adenosine-induced controlled hypotension. Regional blood flow measured with 15-μm radioactive microspheres was used to calculate regional oxygen supply. Hemodilution with 5% dextran (40,000 molecular weight) reduced arterial hematocrit and oxygen contentby approximately one-half and caused heterogeneous changes in regional blood flows; flow decreased in the spleen, was unchanged in the renal cortex, liver, skeletal muscle and skin, and increased in the duodenum, pancreas, brain and myocardium; however, only inthe brain and myocardium were increases in flow sufficient to preserve oxygen supply. Intravenous infusion of adenosine reduced aortic pressure by 50% and reduced flow in most tissues (renal cortex, pancreas, liver, spleen, skin, and brain), with the result that oxygen deficits were produced or accentuated in these organs. The magnitude of flow reductions in the renal cortex (−73%) and cerebral cortex (−37%) were noteworthy. In themyocardium, direct coronary vasodilation by adenosine caused parallel increases in blood flow and oxygen supply to levels exceeding prevailing metabolic requirements. It is concluded that 1) during isovolemic hemodilution alone, oxygen supply to the brain and myocardium is maintained at the expense of oxygen supply to less critical organs and, 2) during combined isovolemic hemodilution and adenosine−induced hypotension, oxygen is oversupplied to the myocardium but undersupplied to the brain and kidney. These latter effects suggest the need for extensive clinical monitoring of patients in whom combined isovolemic hemodilution and adenosine−induced hypotension is utilized.
长期、超最大剂量腺苷期间持续冠状血管舒张。
DOI：
10.1152/ajpheart.1984.247.5.h869
发表时间：
1984
期刊：
The American journal of physiology
影响因子：
--
作者：
Crystal,GJ;Downey,HF;Bashour,FA
通讯作者：
Bashour,FA
腺苷对完整和培养的血管平滑肌钙吸收的影响。
DOI：
10.1152/ajpheart.1982.242.5.h797
发表时间：
1982
期刊：
The American journal of physiology
影响因子：
--
作者：
Fenton,RA;Bruttig,SP;Rubio,R;Berne,RM
通讯作者：
Berne,RM