Sampson James B, Davis Michael R, Mueller Deborah L, Kashyap Vikram S, Jenkins Donald H, Kerby Jeffrey D
Department of General Surgery, Wilford Hall Medical Center, Lackland, Texas 78236-5300, USA.
J Trauma. 2003 Oct;55(4):747-54. doi: 10.1097/01.TA.0000084519.47163.77.
The ideal resuscitation fluid for military applications would be effective at low volumes, thereby reducing logistical constraints. We have previously shown that the bovine hemoglobin-based oxygen carrier HBOC-201 is an effective low-volume resuscitation fluid. The goal of this experiment was to evaluate the effectiveness of HBOC-201 in comparison with other low-volume resuscitation fluids in a swine model of controlled hemorrhagic shock.
Forty-two immature female Yorkshire swine (55-70 kg) were divided into seven groups of six. Animals were hemorrhaged to a mean arterial pressure of 30 mm Hg. After 45 minutes, animals were resuscitated to a mean arterial pressure of 60 mm Hg with one of the following agents: hypertonic saline 7.5% (HTS), hypertonic saline 7.5%/Dextran-70 6% (HSD), pentastarch 6%, hetastarch 6%, or HBOC-201. Lactated Ringer's (LR) solution was used as a standard resuscitation control. Another group of animals received no resuscitation. Resuscitation was continued for 4 hours. Hemodynamic variables and oxygen consumption were measured continuously. Arterial and mixed venous blood gases and serum lactate levels were measured at intervals throughout the experiment. Data were analyzed using analysis of variance with Tukey's post hoc test when appropriate. Significance was defined as p < 0.05.
Five of six animals in the no-resuscitation control group, six of six in the HTS group, and one animal in the HSD group died before completion of the study. All other animals survived to completion. Animals receiving resuscitation with HBOC-201 had significantly lower cardiac output, mixed venous oxygen saturation levels, and urinary output throughout the resuscitation period; however, there were no differences with regard to lactate, base excess, or oxygen consumption. Animals receiving HBOC-201 required significantly less fluid than any other group.
In this model, hypotensive resuscitation with HBOC-201 restores tissue oxygenation and reverses anaerobic metabolism at significantly lower volumes when compared with HTS, HSD, pentastarch, or hetastarch solutions. These data suggest that HBOC-201 would be an effective primary resuscitation fluid for far-forward military or rural trauma settings where logistic constraints and prolonged transport times are common. However, when HBOC-201 is administered as a primary resuscitation fluid in hypotensive protocols, common clinical markers for determining adequacy of resuscitation may not be useful.
适用于军事用途的理想复苏液应在低容量时有效，从而减少后勤限制。我们之前已表明，基于牛血红蛋白的氧载体HBOC-201是一种有效的低容量复苏液。本实验的目的是在可控失血性休克猪模型中，将HBOC-201与其他低容量复苏液相比较，评估其有效性。
42只未成熟雌性约克夏猪（55 - 70千克）被分为7组，每组6只。将动物出血至平均动脉压为30毫米汞柱。45分钟后，用以下其中一种药物将动物复苏至平均动脉压60毫米汞柱：7.5%高渗盐水（HTS）、7.5%高渗盐水/6%右旋糖酐-70（HSD）、6% pentastarch、6%羟乙基淀粉或HBOC-201。乳酸林格氏（LR）溶液用作标准复苏对照。另一组动物未进行复苏。复苏持续4小时。连续测量血流动力学变量和氧消耗。在整个实验过程中间隔测量动脉和混合静脉血气以及血清乳酸水平。数据在适当情况下使用方差分析及Tukey事后检验进行分析。显著性定义为p < 0.05。
未复苏对照组的6只动物中有5只、HTS组的6只动物中有6只以及HSD组的1只动物在研究完成前死亡。所有其他动物存活至实验结束。接受HBOC-201复苏的动物在整个复苏期间的心输出量、混合静脉血氧饱和度水平和尿量显著较低；然而，在乳酸、碱剩余或氧消耗方面没有差异。接受HBOC-201的动物所需液体量明显少于其他任何组。
在该模型中，与HTS、HSD、pentastarch或羟乙基淀粉溶液相比，用HBOC-201进行低血压复苏能以显著更低的液体量恢复组织氧合并逆转无氧代谢。这些数据表明，HBOC-201对于后勤限制和运输时间延长情况常见的前沿军事或农村创伤环境将是一种有效的初始复苏液。然而，当在低血压方案中将HBOC-201用作初始复苏液时，用于确定复苏充分性的常见临床指标可能并无用处。
