| An Experimental Study of the Effect of Colloid Oncotic Pressure on Cardiopulmonary Vascular System . |
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Kwang Woo Kim |
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Department of Anesthesiology, College of Medicine, Seoul National University, Seoul, Korea. |
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| Abstract |
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20 of mongrel dogs induced hemorrhagic hypotensive state by bleeding through fernoral artery with one third of cardiac output, and divided into two experimental groups; one for autologous autotransfusion and the other for normovolemic hemodilution with infusion of 200c.c. of Hartmann's solution, and hypervolemic hemodilution with infusion of 800c.c. of Hartmann's solution. 4 channel monitor(Space lab Inc.) was recorded for electrocardiogram, mean artery pressure(MAP) by cannulation in femoral artery, mean central venous pressure(CVP), mean pulmonary artery pressure(PAP), and mean pulmonary capillary wedge pressure (PCWP) by IL 5F-thermal dilution catheter. Cardiac output was measured with IL 701-702 cardiac output computer system (Instrumentation Laboratory Inc.) connected IL thermaI dilution catheter by thermodilution principle. Colloid oncotic pressure(COP) was measured with IL 186 Weil oncometer system. We evaluated significances of COP and COP-PCWP gradient in various status of bleeding, autologous retransfusion, acute normovolemic and hypervolemic hemodilution with surveying cardiopulmonary hemodynamic changes in dogs. Results were followings; A) Autologous retransfusion study. Average MAP decreased from 138 torr to 70 torr by bleeding of 260 c.c. blood and increased to 118 torr by retransfusion of shed blood. During hemorrhagic hypotensive state, average values of CVP (6+/-0. 12 torr), PAP (16+/-0. 23 torr) PCWP (80+/-0.8 torr), CO (0.5+/-0.03 L/min), SVR(10,240+/-67.5 dyne*sec/cm(5)) and COP (15.7+/-0.2 torr) were significantly decreased than mean control values of CVP(9+/-0.08 torr), PAP(18+/-0.14 torr), PCWP(11+/-0.15 torr), .and CO(0.8+/-0.004L/min) (p<0.005).
Average values of PVR(1,280+/-7.28dyne*sec/cm(5))and PVR/SVR ratio(0.13)in hypotensive state were increased than those of control values(respectively, 700+/-5.25 dyne*sec/cm(5), 0.05) with minimal increased COP-PCWP gradient(from 7.6 torr as control, 7.7 torr after bleeding). After autologous retransfusion in same amounts. average values of CVP (8+/-0.1 torr), PAP (24+/-0.27 torr), PCWF(13+/-0.19 torr), CO(1.0+/-0.01L/mn), and COP(17.9+/-0.23 torr) were increased than those of after bleeding. Average values of SVR(9,440+58,2 dyne sec/cm), PVR(880+/-4.28 dyne*sec/cm), PVR/SVR ratio(0.09) and COP-PCWP gradient(+6.9) were decreased than those after bleeding. Average values of PVR and PVR/SVR ratio were larger than those of control. B) Acute normovolemic and hypervolemic hemodilution study by infusion of 200c.c. and 800 c.c. of Hartmann's solution.
Average values of MAP decreased from control value of 170 torr to 74 torr by average 200c.c. of bleeding(1/3 of CO)and increased to 16l torr by infusion of 200c.c. of Hartmann's solution and then changed to 120 torr by infusion of 800c.c.
of Hartmann's solution(p<0.005). After infusion of 200c.c.
of Hartmanns solution, average value of CVP(12+/-0.15 torr), PAP (28+/-0.33 torr), PCWP (100+/-0.08 torr), CO(0.7+/-0.008 L/min) and SVR (17, 028+/-90.2 dyne*sec/cm') were larger than those after bleeding; CVP (11+/-0.13 torr) PAP (16+/-0.
23 torr), PCWP (5+/-0.05 torr) CO (0.4+/-0.002 L/min) and SVR (12, 600>70. 8 dyne*sec/cm) (p<0.005). Among above average values after infusion of 200 c.c. of Hartmanns solution, PAP is only the value larger than the control value, and remainders were same or smaller than the control value. Average values of PVR(2,057+/-14.32 dyne* sec/cm) and PUR/SVR ratio(0.12) were smaller than those after bleeding; PVR(2,200+/-15.33 dyne*sec/cm) and PVR/SVR ratio(0. 18).
After infusion of 800 c.c. of Hartmann's soltuion, average alues of CVP (17+/-0.20 torr), PAP(31+/-0.05 torr), PCWP(15+/-0.12 torr), CO (2.1+/-0.009L/min) were larger than those of control and after bleeding and 200c.c. of infusion of Hartmanns solution(p<0.005). PVR(609+/-8.44 dyne*sec/cm) and SVR(S,924+/-35, 3 dyne sec/cm) were decreased from the state of 200 c.c. of infusion of Hartmanns solution(p<0.005) with larger value of PVR/SVR ratio(0.15). Average values of COP (12.1+/-0. 13 torr) and COP-PCWP gradient(2.1 torr) were gradually decreased with increased amounts of infused Hartmann's solution(p<0.005). |
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