Efficacy of resuscitative infusion with hemoglobin vesicles in rabbits with massive obstetric hemorrhage
Efficacy of resuscitative infusion with hemoglobin vesicles in rabbits with massive obstetric hemorrhage
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DOI：
10.1016/j.ajog.2020.09.010
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发表时间：
2021-03-26
影响因子：
9.8
通讯作者：
Terui, Katsuo
中科院分区：
文献类型：
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作者：
Yuki, Yukako;Hagisawa, Kohsuke;Terui, Katsuo
背景技术背景：血红蛋白囊泡作为人工氧载体已被开发出来，它们有可能作为红细胞输注的替代品。目的：本研究旨在评价血红蛋白囊泡输注替代红细胞输注用于产科大出血兔的初始治疗的有效性。研究设计：妊娠新西兰白色兔（妊娠第28天;正常妊娠期，29-35天）通过横切子宫肌层中的右中动脉和伴行静脉进行不受控制的出血以诱导休克。随后，通过股静脉对家兔进行等容液体复苏，每5分钟出血一次。复苏输注方案包括5%人血清白蛋白（n=6）、储存的洗涤红细胞与血浆（vol/vol=1：1; n=5）和血红蛋白囊泡与5%人血清白蛋白（vol/vol=4：1; n=5）。结果：在液体复苏过程中，血红蛋白囊泡输注和红细胞输注可维持平均动脉压>50 mm Hg和血红蛋白浓度>9 g/dL，并可防止血浆乳酸升高。相反，仅用5%人血清白蛋白复苏不能预防失血性休克，表现为低平均动脉压（40 mm Hg）、低血红蛋白浓度（2 g/dL）和血浆乳酸盐显著升高。红细胞组和血红蛋白囊泡组动物均存活8h以上，而5%人血白蛋白组动物均在8h内死亡。结论：血红蛋白囊泡输注可有效地用于产科大出血的初期处理。
BACKGROUND: Hemoglobin vesicles have been developed as artificial oxygen carriers, and they have the potential to serve as a substitute for red blood cell transfusion.OBJECTIVE: This study aimed to evaluate the efficacy of hemoglobin vesicle infusion for the initial treatment instead of red blood cell transfusion in rabbits with massive obstetric hemorrhage.STUDY DESIGN: Pregnant New Zealand white rabbits (28th day of pregnancy; normal gestation period, 29-35 days) underwent uncontrolled hemorrhage to induce shock by transecting the right midartery and concomitant vein in the myometrium. Subsequently, rabbits received isovolemic fluid resuscitation through the femoral vein with an equivalent volume of hemorrhage every 5 minutes. Resuscitative infusion regimens included 5% human serum albumin (n=6), stored washed red blood cells with plasma (vol/vol=1:1; n=5), and hemoglobin vesicle with 5% human serum albumin (vol/vol=4:1; n=5). A total of 60 minutes after the start of bleeding, rabbits underwent surgical hemostasis by ligation of the bleeding vessels and then were monitored for survival within 24 hours.RESULTS: During fluid resuscitation, hemoglobin vesicle infusion and red blood cell transfusion maintained a mean arterial pressure of >50 mm Hg and a hemoglobin concentration of >9 g/dL and prevented the elevation of plasma lactate. In contrast, resuscitation with 5% human serum albumin alone could not prevent hemorrhagic shock as evidenced by a low mean arterial pressure (40 mm Hg), a low hemoglobin concentration (2 g/dL), and a marked elevation of plasma lactate. All animals in the red blood cell group and the hemoglobin vesicle group survived more than 8 hours, whereas all animals in the 5% human serum albumin group died within 8 hours.CONCLUSION: Hemoglobin vesicle infusion may be effective in the initial management of massive obstetric hemorrhage.