Isovolemic exchange transfusion with increasing concentrations of low oxygen affinity hemoglobin solution limits oxygen delivery due to vasoconstriction
Isovolemic exchange transfusion with increasing concentrations of low oxygen affinity hemoglobin solution limits oxygen delivery due to vasoconstriction
复制标题
DOI：
10.1152/ajpheart.00751.2008
复制
发表时间：
2008-11-01
影响因子：
4.8
通讯作者：
Intaglietta, Marcos
中科院分区：
文献类型：
--
作者：
Cabrales, Pedro;Tsai, Amy G.;Intaglietta, Marcos
吴伟杰，王伟杰，王伟杰.随着低氧亲和力血红蛋白溶液浓度的增加，等容交换输血由于血管收缩而限制了氧气输送。美国生理学杂志心脏循环生理学295：H2212-H2218，2008年。首次发表于2008年10月3日; doi：10.1152/ajpheart.00751.2008。基于血红蛋白（Hb）的携氧流体处于临床试验的各个阶段，以确定其作为携氧血浆膨胀剂的适用性。聚合血红蛋白溶液的特征在于其血管活性、低O-2亲和力、增敏作用、延长的保存期和稳定性。在仓鼠窗室模型中研究了急性中度贫血时聚合牛血红蛋白（PBH）交换输血后促进O-2转运的生理反应，以确定PBH如何影响微血管灌注和组织氧合。通过使用血浆扩张剂（70 kDa右旋糖酐）进行血液稀释诱导贫血状态[29%红细胞压积（Hct）]。血液稀释后，将动物随机分配至不同的换血组。研究组基于所用PBH的浓度，即：13 g Hb/dl的PBH [PBH 13]，在匹配胶体渗透压（COP）下在白蛋白溶液中稀释至8（PBH 8）或4（PBH 4）g Hb/dl的PBH，以及在匹配COP（PBH 0）下无PBH（仅白蛋白溶液）。在18%Hct下测量全身参数、微血管血流动力学、毛细血管灌注以及血管内和组织O-2水平。用PBH 13恢复O-2携带能力增加动脉压并引发血管收缩、低灌注和高外周阻力。与PBH 13相比，PBH 4和PBH 0表现出较低的动脉压。与PBH 13相比，PBH 8和PBH 4交换输血动物更好地维持灌注和功能性毛细血管密度。血气参数和酸碱平衡恢复与微血管灌注成正比。PBH 4和PBH 8通过阻止O-2毛细血管前释放和增加O-2储备来改善动脉O-2张力。进一步的研究，以建立PBH的最佳剂量，疗效，安全性，其效果的结果表明，在血红蛋白为基础的O-2携带血液替代品在常规实践中实施。
Cabrales P, Tsai AG, Intaglietta M. Isovolemic exchange transfusion with increasing concentrations of low oxygen affinity hemoglobin solution limits oxygen delivery due to vasoconstriction. Am J Physiol Heart Circ Physiol 295: H2212-H2218, 2008. First published October 3, 2008; doi: 10.1152/ajpheart.00751.2008.-O-2-carrying fluids based on hemoglobin (Hb) are in various stages of clinical trials to determine their suitability as O-2-carrying plasma expanders. Polymerized Hb solutions are characterized by their vasoactivity, low O-2 affinity, oncotic effect, prolonged shelf life, and stability. Physiological responses to facilitated O-2 transport after exchange transfusion with polymerized bovine Hb (PBH) were studied in the hamster window chamber model during acute moderate anemia to determine how PBH affects microvascular perfusion and tissue oxygenation. The anemic state [29% hematocrit (Hct)] was induced by hemodilution with a plasma expander (70 kDa dextran). After hemodilution, animals were randomly assigned to different exchange transfusion groups. Study groups were based on the concentration of PBH used, namely: PBH at 13 g Hb/dl [PBH13], PBH diluted to 8 (PBH8) or 4 (PBH4) g Hb/dl in albumin solution at matching colloidal osmotic pressure (COP), and no PBH (only albumin solution) at matching COP (PBH0). Measurement of systemic parameters, microvascular hemodynamics, capillary perfusion, and intravascular and tissue O-2 levels was performed at 18% Hct. Restitution of O-2-carrying capacity with PBH13 increased arterial pressure and triggered vasoconstriction, low perfusion, and high peripheral resistance. PBH4 and PBH0 exhibited lower arterial pressures compared with PBH13. Exchange transfused animals with PBH8 and PBH4 better maintained perfusion and functional capillary density than PBH13. Blood gas parameters and acid-base balance were recovered proportional to microvascular perfusion. Arterial O-2 tensions were improved with PBH4 and PBH8 by preventing O-2 precapillary release and increasing O-2 reserve. Further studies to establish PBH optimal dosage, efficacy, safety, and its effect on outcome are indicated before Hb-based O-2-carrying blood substitutes are implemented in routine practice.