Significance of pH changes of arterial blood in patients with acute left heart failure / 中国综合临床

Objective To investigate the pH changes of arterial blood in patients with acute left heart failure.Methods Thirty-eight patients with acute left heart failure were selected as our subjects,who all underwent diuresis,the strong heart diuresis,dilation of blood vessels,reducing the load on the heart,and making water and electrolyte balance of conventional medication,and then parallel oxygen mask,respirator mode synchronized intermittent mandatory ventilation(SIMV).If hypoxia was not significantly improved,and positive pressure ventilation with end expiratory(PEEP) treatment was conducted.Results After treatment,the level of pH,heart rate(HR),breathing rate(RR),arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2) and mean arterial pressure(MAP) were (7.4 ± 0.3,86.3 ± 6.2) times/min,(22.5 ±4.8) times/min,(84.8 ±7.3) mmHg,(43.3 ±5.5) mmHg,(81.1 ±3.2) mmHg,different from those before treatment(7.1 ±0.1),(118.3 ±8.2) times/min,(36.2 ±7.1) times/min,(47.2 ±6.6) mmHg,(48.3 ±5.2) mmHg,(96.2 ±4.5) mmHg),and the differences were significant (t =5.848,19.188,9.854,23.552,4.072,16.857 respectively; P ＜ 0.01).With the progress of treatment,pH value and pHi value in patients showed a rising trend.Regression analysis showed a positive correlation and the regression equation was Y =-0.559 4 + 1.103 7X.Conclusion Patients with acute left heart failure show abnormal blood pH level and the corresponding change inside red blood cells.Then it causes changes in arterial blood oxygen carrying capacity of red blood cells,reduces the cell through the capillary capacity.Therefore,it can result in decrease of gas exchange levels in patients and hypoxia.Treatment should be considered imbalance the body of the improved state of acid-base.

The Effects of Combined Use of Hemodilution and Induced Hypotension on Hemodynamics and Oxygen Carrying Capacity in the Patients Under Posterior Spinal Fusion / 대한마취과학회지

To decrease homologous transfusion and bleeding, hemodilution may be combined with in- duced hypotension. The effects of the above method on hemodynamics and oxygen carrying capacity in human is not studied. Ten patients, age 16-62 yr, having posterior spinal fusion, were studied. Acute preoperative hemodilution to hematocrit 27% with infusion of 10% pentastarch was performed in the patients. After induction of anesthesia and positioning we deereased mean arterial pressure to around 55mmHg by isoflurane and sodium nitroprusside. We observed the changes of hemodynamics and oxygen carrying capacity before hemodilution, after hemodilution, after induced hypotension and before the end of operation. After hemodilution, heart rate and arterial pressure were not changed significantly. Cardiac output and central venous pressure increased significantly. Systemic vascular resistance decreased significantly. There were no significant changes in arterial and mixed venous blood gas analysis. Oxygen flux was not changed significantly. Oxygen consumption and oxygen extraction ratio increased significantly but remained within normal range. After induced hypotension, heart rate was not changed. Cardiac output became lower than that after hemodilution, but was not different from the preoperative value. Systemic vascular resistance became lower than the preoperative value. There were no significant changes in arterial and mixed venous blood gas analysis except for mixed venous blood oxygen saturation. The mixed blood oxygen saturation increased to the preoperative level. Oxygen flux decreased, but oxygen consumption and oxygen extraction ratio were not significantly different from the preoperative values. There were no clinically significant changes in hemodynamics and oxygen carrying capacity before the end of operation. By the above results, we concluded that the combined use of hemodilution and induced hypotension is safe in the aspect of hemodynamics and oxygen carrying capacity.

THE EFFECTS OF HEMODILUTION ON HEMODYNAMICS AND OXYGEN CARRYING CAPACITY IN GRAVID EWE AND FETAL LAMB / 대한마취과학회지

Massive bleeding during pregnancy has a significant effect on the mother and the fetus. To evaluate the safety of hemodilution as a therapy for hemorrhage during pregnancy, the author compared maternal and fetal hemodynamics and oxygen carrying capacity at varying conditions in gravid ewes. Six Corriedale-breed, near-term pregnant ewes (120-140 days gestation) were anesthetized with nitrous oxide, halothane and oxygen. After the vital signs became stable, the maternal and fetal parameters of hemodynamics and oxygen carrying capacity were measured as control values. After then, 15% of total estimated matemal blood volume (12.5 ml/kg) was removed over approximately 15 minutes and infusion of the same amount of a mixture of lactated Ringer's solution and 10% pentastarch was done simultaneously (15% bleeding). Twenty minutes later the same parameters were measured. After then, a second phlebotomy was performed to remove an additional 15% of the total estimated maternal blood volume and infusion of the same amount of a mixture of the same solutions was done simultaneously (30% bleeding). And the same parameters were measured. Data collections included matemal heart rate, systolic, diastolic and mean arterial pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, hemoglobin, hematocrit, serum lactate, arterial and mixed venous pH, oxygen tension, carbon dioxide tension, oxygen saturation, and fetal heart rate, systolic, diastolic and mean arterial pressure, hemoglobin, hematocrit, serum lactate, and umbilical arterial and venous blood gas analysis. Matemal arterial blood pressure, heart rate, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and carfiac output revealed no significant changes, and there was neither hypoxemia nor acidosis in gravid ewes. Serum lactate concentration at 30% bleeding increased significantly but within normal range. Oxygen flux, oxygen consumption and oxygen extraction ratio revealed no significant differences. In fetal lamb blood pressure was not changed, but heart rate, serum lactate concentration and oxygen extraction ratio were revealed significant increases in 15% bleeding and 30% bleeding cases. In conclusion, gravid ewe was well tolerated to acute hemodilution, and.fetal lamb was well compensated.