Small-volume resuscitation from hemorrhagic shock using high-molecular-weight tense-state polymerized hemoglobins.
Small-volume resuscitation from hemorrhagic shock using high-molecular-weight tense-state polymerized hemoglobins.
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使用高分子量紧张态聚合血红蛋白对失血性休克进行小容量复苏。
DOI：
10.1097/ta.0b013e3182028ab0
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Cabrales,Pedro
中科院分区：
文献类型：
--
作者：
Palmer,AndreF;Zhang,Ning;Zhou,Yipin;Harris,DavidR;Cabrales,Pedro
背景：本研究的目的是确定血浆携氧能力在失血性休克（HS）复苏过程中的作用。方法：在仓鼠窗室模型中研究了用高渗盐水进行小容量复苏，然后输注超高分子量紧张态聚合血红蛋白（PolyHbs）的血流动力学反应。抽取50%血容量（BV）诱发HS，维持低血容量状态1小时。通过输注高渗盐水（BV 的 3.5%），然后输注 10% BV 的聚合人 Hb（PolyHb hum，P 50= 49 mm Hg）、聚合牛 Hb（PolyHb bov，P 50= 40 mm Hg）或人血清白蛋白（HSA）（浓度均为 10 g/dL）来实施复苏。复苏监测超过 90 分钟。结果：PolyHb hum 引起动脉压升高，产生血管收缩，并减少灌注。相反，与 PolyHb hum 相比，PolyHb bov 和 HSA 表现出较低的血压，并且部分恢复了灌注和功能性毛细血管密度。与 PolyHb hum 和 HSA 相比，PolyHb bov 复苏后血气参数显着恢复。 PolyHb bov 组的组织 Po 2 显着改善，表明与仓鼠血液相比，PolyHb bov 的 P 50 适度增加（P 50 = 32 mm Hg）在复苏过程中是有益的。然而，由 PolyHb hum 引起的中枢和外周循环之间氧气释放的过度增加会产生血管收缩和灌注不足，从而限制了额外携氧能力的益处。结论：适当设计的 PolyHb 将增强/恢复氧合，而不会引起高血压或血管收缩，可用于输血在逻辑上不可行的情况。
Background:The objective of this study was to determine the role of plasma oxygen carrying capacity during resuscitation from hemorrhagic shock (HS).Methods:Hemodynamic responses to small-volume resuscitation from HS with hypertonic saline followed by infusion of ultrahigh-molecular-weight tense-state polymerized hemoglobins (PolyHbs) were studied in the hamster window chamber model. HS was induced by withdrawing 50% of the blood volume (BV), and hypovolemic state was maintained for 1 hour. Resuscitation was implemented by infusion of hypertonic saline (3.5% of BV) followed by 10% of BV infusion of polymerized human Hb (PolyHb hum, P 50= 49 mm Hg), polymerized bovine Hb (PolyHb bov, P 50= 40 mm Hg), or human serum albumin (HSA), all at 10 g/dL. Resuscitation was monitored over 90 minutes.Results:PolyHb hum elicited higher arterial pressure, produced vasoconstriction, and decreased perfusion. In contrast, PolyHb bov and HSA exhibited lower blood pressure and partially restored perfusion and functional capillary density compared with PolyHb hum. Blood gas parameters showed a pronounced recovery after resuscitation with PolyHb bov compared with both PolyHb hum and HSA. Tissue Po 2 was significantly improved in the PolyHb bov group, showing that the moderate increase in P 50 of PolyHb bov compared with hamster blood (P 50= 32 mm Hg) was beneficial during resuscitation. However, an excessive increase in oxygen release between the central and peripheral circulation, as induced by PolyHb hum produced vasoconstriction and hypoperfusion, limiting the benefits of additional oxygen carrying capacity.Conclusions:Appropriately engineered PolyHb will enhance/reinstate oxygenation, without hypertension or vasoconstriction, to be used in situations where blood transfusion is not logistically feasible.
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