【作者】 曾涟；

【导师】 胡振快；

【作者基本信息】 广西医科大学 ， 麻醉学， 2003， 硕士

【摘要】 目的：观察急性等容血液稀释(ANH)对家兔小肠氧代谢的影响，探讨小肠氧代谢失衡时血液稀释的极限程度，全身与小肠氧代谢的平衡状况。方法：选择成年健康家兔28只，随机分为4组，每组7只，即中度血液稀释组(H1组)，重度血液稀释组(H2组)，极度血液稀释组(H3组)，对照组(H0组)。在稀释前(T1)、稀释后(T2)两个时点同步抽肠系膜上动脉、肠系膜上静脉、股动脉和颈内静脉血样本，进行血气分析,并测定股动脉血乳酸盐含量(ABL)和肠系膜上静脉、颈内静脉血乳酸盐含量(VBL)，计算全身及小肠的动脉血氧含量 (CaO2)、静脉血氧含量(CvO2)、氧摄取率(ERO2)、静脉-动脉乳酸含量差（VADL）等参数。结果：各稀释组家兔稀释前所有指标与H0组比较均无显著性差异。各组家兔MAP在稀释前后无变化，稀释后重度和极度稀释组HR增快(P <0.01)。在血液稀释后H1、H2、H3组Hct降为24.33%±2.48%、14.97%±2.11%、9.59%±0.56%，达到中度、重度、极度血液稀释水平；全身和小肠的CaO2和CvO2降低。血液稀释后全身和小肠的ERO2升高， H2、H3组与H0组比较有<WP=5>显著性差异(P<0.01)。在血液稀释后全身ABL、全身和小肠的VBL和VADL升高，H3组与H0组比较有显著性差异(P<0.01)。各组内同一时点全身与小肠所有指标相比均无显著性差异。结论：中度ANH不影响小肠氧代谢；重度ANH时小肠ERO2升高，仍在代偿范围内；极度ANH小肠氧供需失衡，出现无氧代谢。全身与小肠氧代谢平衡趋势一致。更多还原

【Abstract】 【Objective】To observe the effects of acute normovolemic hemodilution(ANH) on intestinal oxygen metabolism in anesthetized rabbits ,and investigate the limits of ANH that result in intestinal anaerobic metabolism. To study the tendence of intestinal and systemic oxygen metabolism.【Methods】 Twenty-eight rabbits were divided into three hemodilution groups( H1, H2 and H3 groups) and one control group (H0 group) randomly. The different degree of ANH ,namely moderate( H1 ,Hct = 24.33%) ,severe ( H2, Hct = 14.97%) and extreme(H3 ,Hct =9.59% ),were accomplished by exchanging whole blood with 4% Gelofusion. Superior mesenteric arterial and superior mesenteric venous blood gas, femoral arterial and internal jugular venous blood gas, femoral arterial blood lactate value(ABL), superior mesenteric venous and internal jugular venous blood lactate value (VBL) ,were measured prior to hemodilution and 1 hour after hemodilution . Diference of oxygen content , oxygen extraction ratio(ERO2) and venous-arterial difference of lactate (VADL) were calculated. 【Results】Mean arterial pressure of all rabbits were stable, and heart rate increased<WP=7>after ANH in H2 and H3 groups. As compared with H0 group,both intestinal and systemic CaO2 ,CvO2 decreased significantly after ANH in H1,H2 and H3 groups. There was a significant(P<0.01) increase in ERO2 after ANH in H2 and H3 groups; whereas no significant difference was found in H1 group. ABL ,VBL and VADL increased significantly after ANH in H3 group; and no change was found in H1 and H2 groups. Compared to what was measured before ANH, the tendency was the same as that comparing with H0, besides ERO2 was higher in H1 group .No significant difference was found between all groups before ANH .All of intestinal and systemic mesurements in the same group had no difference. 【Conclusions】 This study suggests that moderate ANH do not affect intestinal oxygen metabolism; severe ANH change intestinal oxygen metabolism,but can be compensated; extreme ANH result in intestinal anaerobic metabolism. Systemic and intestinal oxygen metabolisms are changed at the same ANH degree.更多还原