Transfusion restores blood viscosity and reinstates microvascular conditions from hemorrhagic shock independent of oxygen carrying capacity
Transfusion restores blood viscosity and reinstates microvascular conditions from hemorrhagic shock independent of oxygen carrying capacity
复制标题
DOI：
10.1016/j.resuscitation.2007.03.010
复制
发表时间：
2007-10-01
期刊：
影响因子：
6.5
通讯作者：
Tsai, Amy G.
中科院分区：
文献类型：
--
作者：
Cabrates, Pedro;Intaglietta, Marcos;Tsai, Amy G.
在仓鼠窗室模型中研究了使用来自失血性休克的功能性和非功能性新鲜红细胞（RBC）输注氧气时的全身和微血管血流动力学反应，以确定RBC对流变学和氧转运特性的意义。通过动脉控制出血50%血容量诱导中度失血性休克，并维持低血容量状态1 h。通过输注相当于2.5单位的浓缩红细胞进行容量恢复，并对动物进行90 min随访。复苏研究组为无氧功能新鲜RBC（其中血红蛋白（Hb）转化为高铁血红蛋白（MetHb）[MetRBC]）、全氧功能新鲜RBC [OxyRBC]和10%羟乙基淀粉[HES]作为容量控制溶液。在失血、低血容量性休克和复苏过程中进行全身变量、微血管血流动力学和毛细血管灌注的测量。整个方案后，输注RBC的最终血液粘度为3.8 cP，使用HES复苏的最终血液粘度为2.9 cP（基线：4.2 cP）。具有或不具有携氧能力的RBC的容量恢复比HES恢复更高的平均动脉压（MAP）。输血的功能性毛细血管密度（FCD）显著高于HES，新鲜RBC中存在MetHb不会改变FCD或微血管血流动力学。与OxyRBC相比，HES和MetRBC复苏的氧气输送和提取明显更低。羟乙基淀粉复苏后灌注重建不完全也可能是血液流变学特性恢复不适当的结果，这使代偿机制失衡，似乎与携氧能力降低无关。(c)2007爱思唯尔爱尔兰有限公司所有。rights reserved.
Systemic and microvascular hemodynamic responses to transfusion of oxygen using functional and non-functional packed fresh red blood cells (RBCs) from hemorrhagic shock were studied in the hamster window chamber model to determine the significance of RBCs on rheological and oxygen transport properties. Moderate hemorrhagic shock was induced by arterial controlled bleeding of 50% of the blood volume, and a hypovolemic state was maintained for 1 h. Volume restitution was performed by infusion of the equivalent of 2.5 units of packed cells, and the animals were followed for 90 min. Resuscitation study groups were non-oxygen functional fresh RBCs where the hemoglobin (Hb) was converted to methemoglobin (MetHb) [MetRBC], fully oxygen functional fresh RBCs [OxyRBC] and 10% hydroxyethyl starch [HES] as a volume control solution. Measurement of systemic variables, microvascular hemodynamics and capillary perfusion were performed during the hemorrhage, hypovolemic shock and resuscitation. Final blood viscosities after the entire protocol were 3.8 cP for transfusion of RBCs and 2.9 cP for resuscitation with HES (baseline: 4.2 cP). Volume restitution with RBCs with or without oxygen carrying capacity recovered higher mean arterial pressure (MAP) than HES. Functional capillary density (FCD) was substantially higher for transfusion versus HES, and the presence of MetHb in the fresh RBC did not change FCD or microvascular hemodynamics. Oxygen delivery and extraction were significantly tower for resuscitation with HES and MetRBC compared to OxyRBC. Incomplete re-establishment of perfusion after resuscitation with HES could also be a consequence of the inappropriate restoration of blood rheological properties which unbalance compensatory mechanisms, and appear to be independent of the reduction in oxygen carrying capacity. (c) 2007 Elsevier Ireland Ltd. All. rights reserved.