DOI: https://doi.org/10.15587/2313-8416.2015.51783

An influence of hemoglobin and hematocrit level on the functional state of system hemodynamics and myocardial contractility

Олег Анатольевич Лоскутов

Abstract


In the work it was considered an influence of the different hemoglobin (Hb) and hematocrit (Ht) levels on system hemodynamics parameters and functional state of the heart.

The aim of work was to define the minimally allowable Ht and Hb level in patients who underwent aortocoronary shunting (ACS) when the heart functional state and the system hemodynamics are in line with oxygen and transport function of blood.

Methods. The group of research included 72 patients who underwent ACS with application of 3 aorto-coronal anastomoses. The age of patients was 66,96±1,81 years, mean weight ‒ 86,5±1,44 kg, somatic state corresponded 3–5 point by European system of assessment of operative intervention risk for patients with CHD.

Anesthetic management included anesthesia on the base of sevoflurane (1,5–2,5 МAC) and fentanyl (10–15 mcg/kg for all time of operative intervention). Relaxation was provided with rocuronium bromide.

Artificial circulation was carried out under conditions of moderate hypothermia (central temperature +27 °С – +30 °С). An efficiency of artificial circulation apparatus in the period of perfusion was 2,5 l/min./м2.

Results. At studying the dynamics of parameters that represent myocardial contractility (heart index, HI), shock work index of the left ventricle (SWIlv), the degree of shortening of anteroposterior size of the left ventricle into systole, depending on Ht and Hb level the system hemodynamics state can be characterized as:

‒ at Ht value =23 % – 24 % and Hb level =70 g/l – 75 g/l ‒ hypofunction of system hemodynamics was defined by histological type with low level of oxygen delivery;

‒ at Ht value=25 % – 31 % and Hb level=80 g/l ‒ was defined subcompensated norm-function with low level of oxygen delivery;

‒ at Ht value =32 % – 35 % and Hb level=90 g/l – 110 g/l ‒ was defined norm-function of the system blood circulation.

At calculation of minimally allowable Ht and level Hb using the method of least squares and linear programming there were demonstrated that myocardial contractility  parameters that provide the norm-function state of system blood circulation was defined at the minimal Ht values = 28 % and Hb level= 90 g/l.

Conclusion. On the base of analysis of functional parameters of the system hemodynamics and myocardial contractility Ht values =28% and Hb level=90 g/l are minimally allowable parameters for cardio-surgical patients in early post-perfusion and early postsurgical periods at which an adequate oxygen delivery is ensured


Keywords


aortocoronary shunting; myocardial contractility; minimal allowable hemoglobin and hematocrit level

References


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GOST Style Citations


1. Go, A. S. Executive summary: heart disease and stroke statistics ‒ 2013 update: a report from the American Heart Association [Text] / A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, W. B. Borden et. al. // Circulation. ‒ 2013. ‒ Vol. 127, Issue 1. ‒ Р. 143–152. doi: 10.1161/cir.0b013e318282ab8f

2. Mozaffarian, D. Heart disease and stroke statistics ‒ 2015 update: a report from the American Heart Association [Text] / D. Mozaffarian, E. J. Benjamin, A. S. Go, D. K. Arnett, M. J. Blaha, M. Cushman et. al. // Circulation. ‒ 2014. ‒ Vol. 131, Issue 4. ‒ Р. e29–e322. doi: 10.1161/cir.0000000000000152

3. Гандзюк, В. А. Аналіз захворюваності на ішемічну хворобу серця в Україні [Текст] / В. А. Гандзюк // Український кардіологічний журнал. ‒ 2014. ‒ № 3 – С. 45–52.

4. Устинов, А. В. Кардиохирургия и интервенционная кардиология: проблемы и перспективы развития [Текст] / А. В. Устинов // Український медичний часопис. − 2012. − № 1 (87). – C. 8–10.

5. Curley, G. F. Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis [Text] / G. F. Curley, N. Shehata, C. D. Mazer, G. M. T. Hare, J. O. Friedrich // Critical Care Medicine. – 2014. – Vol. 42, Issue 12. – Р. 2611–2624. doi: 10.1097/ccm.0000000000000548

6. Fakhry, S. M. How low is too low? Cardiac risks with anemia [Text] / S. M. Fakhry, P. Fata // Critical Care. – 2004. – Vol. 8, Issue 2. – Р. 11–14. doi: 10.1186/cc2845 

7. Svenmarker, S. Central venous oxygen saturation during cardiopulmonary bypass predicts 3-year survival [Text] / S. Svenmarker, S. Haggmark, M. Ostman, A. Holmgren, U. Naslund // Interactive CardioVascular and Thoracic Surgery. – 2012. – Vol. 16, Issue 1. – Р. 21–26. doi: 10.1093/icvts/ivs363

8. Roger, V. L. Heart disease and stroke statistics – 2011 update: A report from the American Heart Association [Text] / V. L. Roger, A. S. Go, D. M. Lloyd-Jones, R. J. Adams, J. D. Berry, T. M. Brown et. al. // Circulation. − 2010. − Vol. 123, Issue 4. − P. e18–e209. doi: 10.1161/cir.0b013e3182009701

9. Cabrales, P. Delaying blood transfusion in experimental acute anemia with a perfluorocarbon emulsion [Text] / P. Cabrales, C. J. Briceño // Anesthesiology. – 2011. – Vol. 114, Issue 4. – Р. 901–911. doi: 10.1097/aln.0b013e31820efb36

10. Haase, M. Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury [Text] / M. Haase, R. Bellomo, D. Story, A. Letis, K. Klemz, G. Matalanis et. al // Nephrology Dialysis Transplantation. – 2011. – Vol. 27, Issue 1. – Р. 153–160. doi: 10.1093/ndt/gfr275

11. Cabrales, P. Isovolemic exchange transfusion with increasing concentrations of low oxygen affinity hemoglobin solution limits oxygen delivery due to vasoconstriction [Text] / P. Cabrales, A. G. Tsai, M. Intaglietta // AJP: Heart and Circulatory Physiology. – 2008. – Vol. 295, Issue 5. – Р. H2212–H2218. doi: 10.1152/ajpheart.00751.2008

12. Lawler, P. R. Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis [Text] / P. R. Lawler, K. B. Filion, T. Dourian, R. Atallah, M. Garfinkle, M. J. Eisenberg // American Heart Journal. – 2013. – Vol. 165, Issue 2. – Р. 143–153.e5. doi: 10.1016/j.ahj.2012.10.024







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