Acute dilutional anemia and critical left anterior descending coronary artery stenosis impairs end organ oxygen delivery
Acute dilutional anemia and critical left anterior descending coronary artery stenosis impairs end organ oxygen delivery
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DOI：
10.1097/00005373-199609000-00006
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发表时间：
1996-09-01
影响因子：
--
通讯作者：
Gould, SA
中科院分区：
文献类型：
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作者：
Levy, PS;Quigley, RL;Gould, SA
客观的;继发于冠心病的心脏储备有限可能与终末器官发病有关。在这项研究中，我们调查了贫血在这种现象发病机制中的重要性。设计：非随机对照动物试验。设置：大学医院的动物实验室。受试者：麻醉犬。干预/测量：14 只麻醉犬接受 6% 羟乙基淀粉的等容血液稀释，基线红细胞压积为 40 至20%。使用放射性微球评估局部血流量和心脏指数，每次实验期间记录全身氧输送、消耗、血清乳酸和全身血管阻力，从动脉血和混合静脉血中测定动静脉血氧差，7只狗的左冠状动脉前降支出现医源性严重狭窄（实验组）；七只狗没有（对照）。 主要结果：仅在对照动物中，随着血液稀释至 20%，心脏指数增加了 35%。对照组和实验动物的全身氧输送量均下降，两组的全身耗氧量和乳酸水平均无变化。在肾皮质、脾脏、远端结肠、回肠、胆囊和胃体中，随着血液稀释至 20%，两组的局部 O-2 输送量均显着下降。在实验组的左心室和颈脊髓中也观察到了这一发现。此外，通过血液稀释，脾脏、远端结肠和胆囊中的局部 O-2 输送减少至仅 30%。两组的胃体、胆囊、回肠、肾皮质和远端结肠的区域血流量，以及对照组的脾脏在血液稀释至20%时与基线相比没有变化，然而，在所有其他情况下（对照或实验），除脾脏外，所有其他情况（对照或实验）的区域血流量均随着血液稀释至20%而显着增加，仅实验组中的区域血流量显着减少。结论：这些数据表明，在心脏储备有限的情况下，贫血会损害有氧内脏循环，这些观察结果可能进一步加深我们对冠心病危重患者胆囊炎、胃应激性溃疡、回肠内毒素易位和缺血性结肠炎发病机制的了解。
Objective; Limited cardiac reserve, secondary to coronary disease, may be associated with end organ morbidity, In this study, we investigate the significance of anemia in the pathogenesis of this phenomenon.Design: Nonrandomized controlled animal trial.Settings: Animal laboratory in a university hospital.Subject: Anesthetized dogs.Interventions/Measurements: Fourteen anesthetized dogs underwent isovolemic hemodilution with 6% hetastarch from a baseline hematocrit of 40 to 20%. Radioactive microspheres were used to evaluate regional blood flow and cardiac index, Systemic oxygen delivery, consumption, serum lactate, and systemic vascular resistance were recorded during each experiment, Arterial venous oxygen difference was determined from arterial and mixed venous blood, Seven dogs had an iatrogenic critical stenosis of their left anterior descending coronary artery (experimental group); seven dogs did not (control).Main Results: Only in the control animals, the cardiac index increased by 35% with hemodilution to 20%. Systemic oxygen delivery decreased in both the control and the experimental animals, Systemic oxygen consumption and lactate levels were unchanged in both groups, In the renal cortex, spleen, distal colon, ileum, gallbladder, and stomach body, regional O-2 delivery was significantly decreased with hemodilution to 20% in both groups. This finding was also observed in the left ventricle and cervical spinal cord in the experimental group, In addition, regional O-2 delivery was reduced in the spleen, distal colon, and gallbladder with hemodilution to only 30%. Regional blood flow in the stomach body, gallbladder, ileum, renal cortex, and distal colon, in both groups, and the spleen in the control group was unchanged from baseline with hemodilution to 20%, However, regional blood flow under all other circumstances (control or experimental) was significantly increased with hemodilution to 20% with the exception of the spleen, which showed significant regional blood flow decrease in the experimental group only,Conclusions: These data suggest that with limited cardiac reserve, anemia mag compromise aerobic splanchnic circulation, These observations may further our understanding of the pathogenesis of cholecystitis, gastric stress ulcers, ileal endotoxin translocation, and ischemic colitis in critically ill patients with coronary artery disease.