Heart, kidney, and intestine have different tolerances for anemia
Heart, kidney, and intestine have different tolerances for anemia
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DOI：
10.1016/j.trsl.2007.11.001
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发表时间：
2008-02-01
影响因子：
7.8
通讯作者：
Ince, Can
中科院分区：
文献类型：
--
作者：
Van Bommel, Jasper;Siegemund, Martin;Ince, Can
由于全球和局部的再分配机制，器官系统对全身氧气输送的变化并不一致。我们假设，与肾脏和肠道相比，渐进式血液稀释会在心脏的微血管氧合中引起不同的反应。为了验证这一假设，我们在麻醉和机械通气的大鼠模型上研究了分步等容血液稀释对全身血流动力学和氧合参数的影响，以及系统红细胞压积(Ht)与心、肾和肠微血管PO2(Mu PO2)的关系。血液稀释组和对照组的基线条件相似。血液稀释组Ht由46.6+/-3.8%降至7.0+/-1.8%(平均+/-标准差)。这一组对测量的血流动力学没有影响；只有当Ht降到10%以下时，血压才开始下降。心、肾、肠的MUPO2值反应不一致。当Ht为38.5+/-8.6%时，肾Mu-PO2(基线时为56+/-10 mm Hg)开始下降，而肠道Mu-PO2(基线时为59+/-6 mm Hg)直到Ht达到17.4+/-7.1%时才开始下降。最后，在Ht为8.7+/-3.5%时，心脏Mu-PO2(基线时为40+/-6 mm Hg)仅在实验的最后阶段下降。根据这些观察，我们得出结论，进行性贫血过程中微血管氧合的调节是每个器官系统特有的。这些观察结果与器官功能和损伤之间的关系需要确定。
Organ systems do not respond uniformly to changes in systemic oxygen delivery because of global and local redistributive mechanisms. We hypothesized that progressive hemodilution would evoke a different response in the microvascular oxygenation of the heart compared with kidney and gut. To evaluate this hypothesis, we studied the effect of stepwise isovolemic hemodilution on systemic hemodynamic and oxygenation parameters as well as the relation between systemic hematocrit (Ht) and microvascular PO2 (mu PO2) in heart, kidney, and intestines in an anesthetized and mechanically ventilated rat model.Baseline conditions were similar in the hemodilution group and in the control group. In the hemodilution group, Ht was diminished from 46.6 +/- 3.8% to 7.0 +/- 1.8% (mean +/- standard deviation (SD)). This group had no effect on measured hemodynamics; only when Ht fell below 10% did blood pressure start to decrease. The mu PO2 values in heart, kidney, and intestines did not respond uniformly. Renal mu PO2 (56 +/- 10 mm Hg at baseline) started to decrease at a Ht of 38.5 +/- 8.6%, whereas intestinal mu PO2 (59 +/- 6 mm Hg at baseline) did not start to decrease until Ht reached 17.4 +/- 7.1%. Finally, cardiac mu PO2 (40 +/- 6 mm Hg at baseline) decreased only in the ultimate stage of the experiment at Ht of 8.7 +/- 3.5%.Based on these observations, we conclude that the regulation of microvascular oxygenation during progressive anemia is specific for each organ system. The relation between these observations and organ function and damage needs to be determined.