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體外循環下 酸鹽基平衡 및 電解質變動에 關한 實驗的 硏究

A Study on the Acid-Base Status and Electrolytes in Dogs under Extra-Corporeal Circulation

중앙의학 1967년 13권 2호 p.163 ~ 176
박경민,
소속 상세정보
박경민 (  ) - 서울대학교 의과대학 외과학교실

Abstract


In order to elucidate the electrolytes and acid-base balance involved in the intra-cardiac surgery with the heart-lung machine, 19 dogs were treated with extra-corporeal circulation and 35 dogs used as blood donors. The animals consisted of three groups; the first group being primed with 5% dextrose in water, P.V.P., and heparinized blood in a bubble bag oxygenator; the second group with ACD blood, 7% sodium bicarbonate, and 10% mannitol; the third group with the same constituents as in the second group. In the first and second group 100% oxygen flow was used, and in third group 2. 8% CO2 was added. Sampling of the blood was done from the femoral artery and vein shortly after the induction of anesthesia, prior to, during, and after bypass.
Major electrolytes including Na+, K+, and Cl- were measured to follow the electrolyte disturbance, the arterial pH and CO2 as well as the derived parameters such as buffer base, PCO2, and plasma [HCO3-] were calculated, and the determinations of lactate and pyruvate were performed. For references, observation on the hematologic and hemodynamic pictures together with oxygen saturation were carried out as well. The results are summarized as follows.
[I] The acid-base balance.
(1) The blood of dogs under bypass primed with hemodiluted blood without the bicarbonate (first group) tended to show decreases in the arterial pH, total CO2, buffer base, and plasma [HCO3-] during perfusion, the degree of which was so accentuated as to bring severe metabolic acidosis immediately after the perfusion.
(2) The blood of dogs under bypass primed with ACD blood plus bicarbonate with or without CO2 addition(second and third group) revealed decreases in all parameters mentioned in (1) both in the pre and post-perfusion period, but the tendency toward metabolic acidosis was observed less significant as compared to the result obtained with the first group, which suggests that ACD blood priming with bicarbonate may be effective in preventing metabolic acidosis resulting from extra-corporeal circulation.
(3) pC02 of the blood both during and post perfusion in all groups of dogs under bypass tended to decrease, which is indicative of respiratory alkalosis; and perfusion with saturated CO2, however, failed to exert a compensatory effect over the respiratory alkalosis.
[II] The serum lactate and pyruvate.
The serum levels of pyruvate and lactate both in the second and third groups increased, but the ratio of lactate over pyruvate remained within normal range.
[III] The serum electrolytes.
The perfusion in the first group brought decrease in the serum levels of Na+ and Cl-, with an increase in the level of K+, and the same was true of the second and third groups the magnitude of the latter however, being far less as compared to the former.
[IV] The hematologic pictures.
The erythrocyte, hemoglobin, and hematocrit values were eminently reduced by the perfusion in all groups, the reduction in the second and third however, being less eminent than the first group.
From the above results, it is concluded that perfusion with the CaCl2-and bicarbonate added heparinized ACD blood seems to exert a positive effect in clinical compensation of the electrolytes and acid-base disturbances resulting from extra-corporeal circulation, as compared to the effect brought about by hemodiluted perfusion.

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