【摘要】 目的探讨急性高容量血液稀释(AHHD)对单肺通气犬通气侧和非通气侧肺水的影响。方法32只健康成年杂种犬,雌雄各半,体重12-21kg,随机分为4组(A、B、C和D组),A组行单肺通气,B、C、D组在单肺通气基础上行AHHD,每组8只。各组麻醉诱导后气管插管,游离左侧总支气管后结扎行单肺通气。B、C、D组在单肺通气10 min时经头静脉或股静脉以80 m1·kg-1·h-1的速率输注6%中分子羟乙基淀粉行AHHD,分别将红细胞比容(Hct)降至25%、20%、15%。分别记录双肺通气10 min(双肺通气时)、单肺通气10 min(单肺通气时)和AHHD至预定值(血液稀释时)心率(HR)、收缩压(BP)、舒张压(DP)、平均动脉压(MAP)、心输出量(CO)、每搏输出量(SV)、射血分数(EF)、外周血管阻力(SVR)、中心静脉压(CVP)。A组在单肺通气10min、B、C、D组Hct降至预定值后10 min处死犬。测定肺水参数:肺湿重(W)、肺干重(D)、肺水系数(Qw)、血管内肺水(IVLW)、血管外肺水(EVLW)、总肺水(TLW)、肺含水百分数(H2O%)、肺湿干重比(W/D)。结果D组1只犬出现双侧肺水肿;与A组比较,B、C、D组双侧肺IVLW、TLW、IVLW/D增加,C、D组双侧肺H2O%、W/D和,TLW/D增加,D组双侧肺EVLW、Qw增加(P<0.05或0.01);双侧肺TLW与EVLW的相关系数分别为0.761和0.824(P<0.01)。通气侧、非通气TLW(X)与EVLW(Y)直线回归方程分别为Y=-0.56+0.88X、Y= -4.08+1.62X,r2分别为0.58、0.68(P<0.01)。结论单肺通气犬应用6%羟乙基淀粉行AHHD时, 在Hct降至20%以上时主要是增加了IVLW和TLW,EVLW增加相对较少;而Hct降至15%时,有发生肺水肿的危险。更多还原

【Abstract】 Objective To evaluate the effects of acute hypervolemic hemodilution (AHH) on the lung water of ventilated and nonventilated lungs during one-lung ventilation (OLV) .Methods Thirty-two healthy adult mongrel dogs of both sexes (16 males, 16 females) weighing 12-21 kg were randomly allocated to one of 4 groups (n = 8 each): group A underwent OLV alone without AHH; group B,C and D underwent OLV and AHH which reduced Hct to 25% (B) , 20% (C) and 15% (D). The animals were anesthetized with intramuscular ketamine 8 mg·kg-1 and intravenous thiopental 15 mg·kg-1 and vecuronium 0.12 mg·kg-1, intubated and mechanically ventilated (FiO2= 1.0, VT = 12-15 ml·kg-1 , RR = 6-10 bpm, PET CO2 = 30-40 mm Hg) . Right external jugular vein was cannulated for CVP monitoring and thermodilution catheter (PICCO) was inserted via femoral artery for continuous cardiac output (CO) monitoring. OLV was performed by left thoracotomy and ligation of left main bronchus. AHH was performed by infusion of 6 % HES at 80 ml·kg-1·h-1 until Hct was reduced to 25 % (group B), 20% (group C) or 15% (group D). HR, BP, CVP, CO, stroke volume (SV), ejection fraction (EF) and systemic vascular resistance (SVR) were monitored. 10 rain after Hct was reduced to the desired levels in different groups the animals were killed and lungs removed for determination of wet lung weight (W) , dry lung weight (D), W/D lung weight ratio, lung water quotient (Qw ml·g-1), lung water content (H2O%) and intra-and extra vascular lung water (IVLW, EVLW) .Results The target Hcts were reached in group B, C and D. One dog in group D developed pulmonary edema of both ventilated and non-ventilated lungs. There was no significant change in HR and BP after AHH but CO, SV, EF, CVP were significantly increased while SVR was significantly decreased ( P < 0.05 or 0.01). IVLW was significantly increased in group B, C and D while EVLW was significantly increased only in group D during OLV in both ventilated and non-ventilated lungs after AHH ( P < 0.01 or 0.05). W/D ratio and H2O% were significantly increased in both ventilated and non-ventilated lungs in group C and D compared to group A, while Qw was significantly increased only in group D. TLW and EVLW were closely correlated in both ventilated and non-ventilated lungs but the increase in EVLW in non-ventilated lung water was more pronounced with increasing TLW. Conclusion AHH with 6 % HES mainly increases IVLW and TLW during OLV, but the increase in EVLW is slow and less pronounced. Even when Hct was reduced to 15% pulmonary edema rarely occurs.更多还原