Intraosseous transfusion of hemoglobin vesicles in the treatment of hemorrhagic shock with collapsed vessels in a rabbit model
Intraosseous transfusion of hemoglobin vesicles in the treatment of hemorrhagic shock with collapsed vessels in a rabbit model
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DOI：
10.1111/trf.15915
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发表时间：
2020-06-24
期刊：
影响因子：
2.9
通讯作者：
Sakai, Hiromi
中科院分区：
文献类型：
--
作者：
Hagisawa, Kohsuke;Kinoshita, Manabu;Sakai, Hiromi
背景静脉输液有时会在院前条件下遇到困难，此时周围血管崩溃，无法接触到。我们研究了细胞型血红蛋白基氧载体(血红蛋白囊泡：HBVS)是否允许骨内给药进入血液循环，用于严重失血性休克兔的复苏。研究设计与方法新西兰大白兔(平均体重2.5 kg)建立重度失血性休克模型[平均动脉压(MAP)：21+/-2 mm Hg，Hb 5.1+/-0.8g/dL]。分别于术后即刻骨内输注HbV、5%人血清白蛋白(HSA)、自体全血(WB)、储存红细胞(RBC)或乳酸林格氏(LR)36mL/kg，然后再骨内输注HSA 8mL/kg(输注乙肝病毒、HSA或储存RBC)、WB或LR(输注LR后)24mL/kg。结果骨内输注Hbvs可提高MAP(48+/-9 mm Hg)，改善低血红蛋白血症(7.1+/-0.6g/dL)以及Wb或RBC输注。相反，HSA和LR都没有改善血流动力学或Hb水平。接受HbV的10只兔子中有7只存活了24小时，而接受LR的10只兔子中只有1只存活(WB和RBC；100%存活，HSA；30%存活)。结论骨内输注Hbvs可能是维持急性失血性休克血流动力学的一种有效的早期治疗方法。这种方法可以用于很难接触到周围血管的紧急情况。
BACKGROUNDS Intravenous transfusion sometimes encounters difficulty under prehospital conditions when peripheral vessels are collapsed and inaccessible. We investigated whether the cellular type hemoglobin-based oxygen carriers (Hemoglobin Vesicles: HbVs) allow intraosseous administration into blood circulation for the resuscitation of rabbits with severe hemorrhagic shock. STUDY DESIGN AND METHODS New Zealand white rabbits (2.5 kg average) were set in severe hemorrhagic shock [mean arterial pressure (MAP): 21 +/- 2 mm Hg, Hb 5.1 +/- 0.8 g/dL]. Immediately thereafter, 12 mL/kg of HbVs, 5% human serum albumin (HSA), autologous whole blood (WB), stored red blood cells (RBCs) or 36 mL/kg of Lactated Ringer's (LR) were intraosseously transfused, followed by an additional intraosseous transfusion with 8 mL/kg of HSA (following HbV, HSA or stored RBC transfusion), or WB or 24 mL/kg of LR (following LR transfusion), respectively. RESULTS Intraosseous transfusion of HbVs increased MAP (48 +/- 9 mm Hg) and improved hypohemoglobinemia (7.1 +/- 0.6 g/dL) as well as WB or RBC transfusion. In contrast, neither HSA nor LR improved hemodynamics or Hb levels. Seven out of 10 rabbits receiving HbVs survived for 24 hours, while only one out of 10 rabbits receiving LR survived (WB and RBC; 100% survivals, HSA; 30% survival). CONCLUSIONS Intraosseous infusion of HbVs might be an effective initial treatment to maintain hemodynamics during acute hemorrhagic shock. This approach could be used in emergency situations in which access to peripheral vessels is difficult.