Zusammenfassung
Die Einwirkung massiver Infusion von kaltem (9 bis 11°C) autologem Heparinblut auf die Herztätigkeit wurde im Hundeexperiment untersucht. Die Reinfusion der zur Auslösung eines hypovolämischen Schockzustandes entzogenen Blutmenge (30 bis 40 ml/kg Körpergewicht) führte in unseren Versuchen nicht zum Herzstillstand. Wurde dagegen das gekühlte Blut in Form einer Dauerinfusion gegeben, deren Gesamtmenge das normale Blutvolumen der Versuchstiere um ein Mehrfaches überstieg, so kam es in zwei von sechs Fällen zum Herzstillstand. Die Temperatur im Myokard der rechten Herzkammer betrug beim Eintritt des Herzstillstandes 26,5° bzw. 22,0°C.
Die Problematik der raschen Transfusion großer Mengen von Citratblut wird kurz diskutiert. Es werden Richtlinien für den klinischen Gebrauch aufgestellt.
Summary
The influence of massive infusion of cooled (9 to 11°C) autologous blood on the heart was studied in the dog. The infusions were given at a rate of about 4 ml per kilogram of body weight per minute. The infusion of a quantity of blood smaller than the normal blood volume of the dog as used in the correction of oligemic shock induced by an acute blood loss did not lead to cardiac arrest in any of our cases. The infusion of a quantity of cooled blood which exceeded considerably the normal blood volume of the “patient”, however, did cause cardiac standstill in two out of six cases. The temperature of the myocardium of the right ventricle was 26,5 and 22,0°C respectively in these two cases.
The special problems arising with large transfusions of citrated bank blood are brievely discussed. The authors conclude that in massive transfusions of citrated bank blood the blood should be warmed to body temperature if ever possible. In any case the blood should be warmed after the third or fourth bottle if it must be given in a quantity exceeding 1 1/2 liters and at a rate of 100 ml per minute or faster.
Literatur
Baue, A. E., G. Hermann, andR. S. Shaw: A study of bank blood toxicity. Surg. Gynec. Obstet.113, 40 (1961).
Boyan, C. P., andW. S. Howland: Blood temperature: a critical factor in massive transfusion. Anesthesiology22, 559 (1961).
——: Problems related to massive blood replacement. Anesth. Analg. Curr. Res.41, 497 (1962).
——: Cardiac arrest and temperature of bank blood. J. Amer. med. Ass.183, 58 (1963).
—: Cold or warmed blood for massive transfusion? Ann Surg.160, 282 (1964).
Bunker, J. P., J. B. Stetson, R. C. Coe, H. C. Grillo, andA. J. Murphy: Citric acid intoxication. J. Amer. med. Ass.157, 1361 (1955).
Howland W. S., R. G. Jacobs, andA. H. Goulet: An evaluation of calcium administration during rapid blood replacement. Anesth. Analg. Curr. Res.39, 557 (1960).
Mac Lean L. D., andA. Van Tyn: Ventricular defibrillation. J. Amer. med. Ass.175, 471 (1961).
Markowitz J., J. Archibald, andH. G. Downie: Experimental Surgery. Baltimore: Williams and Wilkins 1964.
Moore, F. D.: Metabolic care of the surgical patient. Philadelphia and London: Saunders 1959.
Nahas, G. G., W. M. Manger, A. Mittelman, andJ. E. Ultmann: The use of 2-amino-2-hydroxymethyl, 3-propanediol in the correction of addition acidosis and its effect on sympathoadrenal activity. Ann. N.Y. Acad. Sci.92, 596 (1961).
Schweizer, O., andW. S. Howland: The effect of citrated bank blood on acid-base balance. Surg. Gynec. Obstet.114, 90 (1962).
Sealy, W. C., W. Glenn Young Jr.,A. M. Lesage, andJ. W. Brown Jr.: Observations on heart action during hypothermia induced and controlled by a pump oxygenator. Ann. Surg.153, 797 (1961).
Seldon, T. H.: Untoward reactions and complications during transfusions and infusions. Anesthesiology22, 810 (1961).
Senning, A.: The risk of rapid and large citrated blood transfusions in experimental hemorrhagic shock. Acta chir. scand.110, 394 (1955).
Stephen, C. R., S. J. Dent, K. D. Hall, andW. W. Smith: Physiologic reactions during profound hypothermia with cardioplegia. Anesthesiology22, 873 (1961).
Le Veen, H. H., H. S. Pasternack, J. Lustrin, R. B. Shapiro, E. Becker, andA. E. Helft: Hemorrhage and transfusion as the major cause of cardiac arrest. J. Amer. med. Ass.173, 770 (1960)
Waters, D. S., andW. W. Mapleson: Mechanism of heat loss during hypothermia induced by surface cooling. Anaesthesia16, 135 (1961).
Zauder, H. L., andL. R. Orkin: Cardiac arrest following massive transfusion. N.Y. St. J. Med.62, 2400 (1962).
Author information
Authors and Affiliations
Additional information
Diese Arbeit wurde durch die Hilfe des Schweizerischen Nationalfonds zur Förderung der wissenschaftlichen Forschung ermöglicht.
Rights and permissions
About this article
Cite this article
Aeberhard, P., Jenny, M. Die Einwirkung massiver Kaltblutinfusion auf die Herztätigkeit beim Hund. Arch. f. klin. Chir 315, 69–78 (1966). https://doi.org/10.1007/BF01440129
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF01440129