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김영재,조강희,박주열,신치만,구영권,김환덕 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.3
Background : The reduction in hematocrit (Hct) by hemodilution tends to cause an increase in cardiac output and a proportional decrease in arterial oxygen content. Additionally the reduction of systemic oxygen delivery (DO2) leads to significant differences in regional blood flow. It is therefore important to characterize the effects of hemodilution on regional oxygen metabolism in individual organs. This study was undertaken to evaluate and compare the effects of acute normovolemic anemia induced by hemodilution. Methods : Six dogs were anesthetized and mechanically ventilated. Catheters were inserted in the right femoral and pulmonary arteries for blood sampling, and a gastric tonometer catheter was inserted into the gastric lumen. Baseline measurements of systemic hemodynamics, arterial ketone body ratio (AKBR), gastric intramucosal pH (pHi) and arterial lactate were recorded. Hemodilution was then begun by 6% pentastarch and was made in four levels of hematocrit values of 20%, 15%, 10% and 6%. Results : Mean arterial pressures of Hct 10% and 6% was decresaed (P < 0.05) and Hct 15% and 10% increases in cardiac output and pulmonary capillary wedge pressure (PCWP) were observed. Central venous pressure and mean pulmonary arterial pressure were incresed (P < 0.05) at Hct 15%, 10% and 6%. DO2 progressively decreased (P < 0.05). AKBR and pHi began to decreased at Hct 15%. Arterial lactate decrease at Hct 15% and was above 7.4 mmol/L at Hct 6%. Conclusions : By the measurements of AKBR and pHi, the disturbance of splanchnic oxygenation can be detected early compared to those of O2 in terms of oxygen metabolism and the critical point of DO2 during acute normovolemic anemia induced by hemodilution. (Korean J Anesthesiol 1999; 37: 478∼488)
실험견의 출혈성 쇽시 Carbicarb와 Sodium Bicarbonate가 산-염기 상태 및 혈역학에 미치는 영향
김영재,박진우,이상화,김성덕,박주열,정순호,신치만,최영균,윤대영 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.2
Background : During hemorrhagic shock, acidosis was frequently treated with sodium bicarbonate, but various adverse reactions were reported. Most adverse effects of sodium bicarbonate have been attributed to increased CO2 production and paradoxical intracellular acidosis. This study was designed to compare the effects of Carbicarb and sodium bicarbonate on hemodynamics and acid base states in canine hemorrhagic shock. Methods : 12 mongrel dogs were randomly divided as sodium bicarbanate group (group 1, n=6) and Carbicarb group (group 2, n=6). The study was divided into three successive phases as prehemorrhagic phase (I), hemorrhagic shock phase (II), acid-base correctoin phase (III 1 min, III 5 min, III 15 min, III 30 min). At the beginning of phase III, group 1 received sodium bicarbonate 2.5 ml/kg and group 2 received Carbicarb 2.5 ml/kg. During each phase a complete set of hemodynamic parameters, arterial and mixed venous blood gas measurements were recorded. Results: 1) Arterial and end-tidal CO2 of sodium bicarbonate treated group were increased significantly compared with that of Carbicarb treated group after treatment. 2) Acidosis was improved in both groups, but pH of Carbicarb treated group showed more increase compared with pH of sodium bicarbonate treated group (P<0.05). 3) There was significant hemodynamic improvement on both group after treatment, but there was no statistical significance between groups. Conclusion : The treatment of Carbicarb shows more increase in arterial pH and less increase in carbon dioxide compared with sodium bicarbonate to treat metabolic acidosis due to hemorrhagic shock in mongrel dogs. So we suggest that Carbicarb is useful in the treatment of metabolic acidosis during hemorrhagic shock. (Korean J Anesthesiol 1998; 35: 197∼203)