双阿司匹林交联血红蛋白可有效恢复失血性休克时的胰腺微循环衰竭。

Diaspirin cross-linked hemoglobin effectively restores pancreatic microcirculatory failure in hemorrhagic shock.

作者信息

von Dobschuetz E, Hoffmann T, Messmer K

机构信息

Institute for Surgical Research, Klinikum Grosshadern Ludwig-Maximilians-University, Munich, Germany.

出版信息

Anesthesiology. 1999 Dec;91(6):1754-62. doi: 10.1097/00000542-199912000-00029.

DOI:10.1097/00000542-199912000-00029

PMID:10598619

Abstract

BACKGROUND

Microvascular reperfusion failure of splanchnic organs is a crucial hallmark in organ damage induced by hemorrhagic shock, which should be prevented by a resuscitation solution. Because the vasoactive properties of the hemoglobin-based oxygen carrier diaspirin cross-linked hemoglobin (DCLHb) could adversely influence restoration of pancreatic capillary perfusion during resuscitation, the authors investigated its effects on the microcirculation of the rat pancreas in comparison with whole blood and 6% hydroxyethylstarch resuscitation from severe hemorrhagic shock.

METHODS

Twenty-eight pentobarbital-anaesthetized rats were bled to a mean arterial pressure (MAP) of 40 mmHg and maintained at this level for 1 h. Using an intravital microscope, mean arterial pressure, the length of erythrocyte-perfused pancreatic capillaries per observation area (functional capillary density), the adherence of leukocytes in postcapillary venules, and pancreatic lipid peroxidation, measured as thiobarbituric acid-reactive material in pancreatic tissue, were determined in animals resuscitated by volumes of hydroxyethylstarch, DCLHb, and whole blood (WB) equivalent to the shed blood volume or in control animals without shock induction for a period of 2 h after resuscitation.

RESULTS

Compared with control animals (366+/-28 cm(-1)), animals resuscitated with DCLHb (294+/-45 cm(-1)), WB (306+/-11 cm(-1)), and hydroxyethylstarch (241+/-34 cm(-1)) showed a significant reduction of functional capillary density after 2 h of resuscitation. DCLHb was as effective as WB and superior to hydroxyethylstarch in restoring functional capillary density and mean arterial pressure. Leukocyte adherence in postcapillary venules was not enhanced by DCLHb (369+/-148/mm2) infusion when compared with hydroxyethylstarch- (615+/-283/mm2) and WB-treated (510+/-415/mm2) animals. Lipid peroxidation of pancreatic tissue was significantly elevated after treatment with both oxygen-carrying solutions compared with hydroxyethylstarch.

CONCLUSION

DCLHb is as effective as WB for preservation of the pancreatic microcirculation.

摘要

背景

内脏器官微血管再灌注失败是失血性休克所致器官损伤的一个关键标志，复苏液应可预防此情况。由于基于血红蛋白的氧载体双阿司匹林交联血红蛋白（DCLHb）的血管活性特性可能会对复苏过程中胰腺毛细血管灌注的恢复产生不利影响，作者将其与全血及6%羟乙基淀粉用于大鼠严重失血性休克复苏时对胰腺微循环的影响进行了比较研究。

方法

28只戊巴比妥麻醉的大鼠被放血至平均动脉压（MAP）为40 mmHg，并维持此水平1小时。使用活体显微镜，在复苏后2小时内，对用相当于失血量的羟乙基淀粉、DCLHb和全血（WB）进行复苏的动物或未诱导休克的对照动物，测定平均动脉压、每个观察区域内红细胞灌注的胰腺毛细血管长度（功能性毛细血管密度）、毛细血管后微静脉中白细胞的黏附情况以及胰腺脂质过氧化水平（以胰腺组织中的硫代巴比妥酸反应物质衡量）。

结果

与对照动物（366±28 cm⁻¹）相比，用DCLHb（294±45 cm⁻¹）、WB（306±11 cm⁻¹）和羟乙基淀粉（241±34 cm⁻¹）复苏的动物在复苏2小时后功能性毛细血管密度显著降低。DCLHb在恢复功能性毛细血管密度和平均动脉压方面与WB效果相当且优于羟乙基淀粉。与羟乙基淀粉处理组（615±283/mm²）和WB处理组（510±415/mm²）动物相比，输注DCLHb（369±148/mm²）并未增强毛细血管后微静脉中白细胞的黏附。与羟乙基淀粉相比，两种携氧溶液处理后胰腺组织的脂质过氧化均显著升高。