术前应用rhuEPO复合急性等容血液稀释对氧平衡的影响

Effects of preoperative rhuEPO therapy coupled with acute normovolemic hemodilution on oxygen balance in anesthetized dogs

目的通过术前应用人工促红细胞生成素 (rhuEPO)对犬急性等容血液稀释时氧供需平衡的影响 ,探讨有效和安全的血液保护措施。方法 16条健康土种犬随机分配为单纯急性等容血液稀释 (ANH)组 (对照组 )和EPO +ANH组 (实验组 )。实验组在术前第 15、11、8、4d及手术当天 ,皮下注射rhuEPO 5 0 0IU/kg并口服铁剂。两组均实施三个步骤的等容血液稀释 ,每次放血 15mL/kg ,总计 4 5mL/kg ,予 6 %低分子右旋糖酐加以替代。结果稀释当天 ,实验组Hct升至 0 .6 3,明显高于对照组 (P <0 .0 5 )。 3次稀释后 ,实验组的Hct和动脉氧含量高于对照组 ,而氧摄取和心排量上升幅度较对照组低。结论EPO能增加机体的氧储备 ,用药后再进行血液稀释对机体氧平衡无明显影响 。

Objective To evaluate the efficacy and safety of EPO coupled with acute normovolemic hemodilution (ANH) to avoid allogenetic blood transfusion. Methods Sixteen dogs were randomly assigned to two groups, ANH group and rhuEPO plus ANH group (preoperative subcutaneous administration of 500 IU/kg rhuEPO at 15, 11, 8,4, 0 d before surgery followed by ANH in the operating room). All dogs underwent 3 step ANH, each step 15 mL/kg blood were removed from the dog, and replaced with equal volume of dextran 40. Results On the day of surgery hematocrit increased to 0.63 in EPO group (P<0.05). After 3 steps ANH, the rhuEPO coupled with ANH group had significantly higher level of hematocrit and arterial oxygen content compared with the other group. CO increased in the two groups, but in the control group the increasing of CO was insufficient to offset the decrease of oxygen content, so we can see an increase in EO 2. Conclusion The oxygen delivery is much better in the EPO coupled with ANH group than in the other group, and it is safe for futher hemodilution.