Strate Tim, Mann Oliver, Kleinhans Helge, Schneider Claus, Knoefel Wolfram T, Yekebas Emre, Standl Thomas, Bloechle Christian, Izbicki Jakob R
Department of General Surgery, University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Ann Surg. 2003 Nov;238(5):765-71. doi: 10.1097/01.sla.0000094442.12395.98.
To evaluate the effectiveness of bovine hemoglobin on pancreatic microcirculation and outcome in experimental acute rodent pancreatitis.
Stasis of the pancreatic microcirculation initiates and aggravates acute pancreatitis. Hydroxyethyl-starch (HES) has been shown to improve pancreatic microcirculation. Similarly, bovine hemoglobin might improve rheology due to its colloid effect, but additionally supplies oxygen to oxygen depleted pancreatic tissue.
In Wistar rats, severe acute pancreatitis was induced by administration of glucodeoxycholic acid i.d. and cerulein i.v. Pancreatic microcirculation was continuously monitored by fluorescence microscopy. Fifteen minutes after the initiation of acute pancreatitis, animals received either 0.8 mL bovine hemoglobin (Oxyglobin), HES, or 2.4 mL 0.9% NaCl i.v. at random. After 6 hours, animals were killed and histopathological damage of the pancreas was assessed using a validated histology score (0-16).
In comparison to controls, pancreatic microcirculation improved significantly in the HBOC group (mean difference of capillary density 31.4%; standard error 5.6%; P < 0.001; 95% confidence interval for difference 17.5-45.3). HES was not as effective as HBOC substitution. The histology score revealed less tissue damage in the HBOC group [6.25 vs. 9.25 (3-8.5 vs. 8-10.75, P < 0.001)] in comparison to controls and also in comparison to the HES group [6.25 vs. 8 (3-8.5 vs. 6.5-10.25, P < 0.006)].
In severe acute pancreatitis, single i.v. injection of bovine hemoglobin improves pancreatic microcirculation and reduces tissue damage.
评估牛血红蛋白对实验性急性啮齿动物胰腺炎胰腺微循环及预后的有效性。
胰腺微循环淤滞引发并加重急性胰腺炎。羟乙基淀粉(HES)已被证明可改善胰腺微循环。同样,牛血红蛋白可能因其胶体效应改善流变学,而且还能为缺氧的胰腺组织提供氧气。
在Wistar大鼠中,通过十二指肠内注射葡萄糖脱氧胆酸和静脉注射雨蛙素诱导严重急性胰腺炎。通过荧光显微镜连续监测胰腺微循环。急性胰腺炎发作15分钟后,动物随机接受0.8 mL牛血红蛋白(氧合球蛋白)、HES或2.4 mL 0.9%氯化钠静脉注射。6小时后,处死动物,使用经过验证的组织学评分(0 - 16)评估胰腺的组织病理学损伤。
与对照组相比,血红蛋白氧载体组的胰腺微循环显著改善(毛细血管密度平均差异31.4%;标准误5.6%;P < 0.001;差异的95%置信区间17.5 - 45.3)。HES不如血红蛋白氧载体替代有效。组织学评分显示,与对照组相比,血红蛋白氧载体组的组织损伤较少[6.25对9.25(3 - 8.5对8 - 10.75,P < 0.001)],与HES组相比也较少[6.25对8(3 - 8.5对6.5 - 10.25,P < 0.006)]。
在严重急性胰腺炎中,单次静脉注射牛血红蛋白可改善胰腺微循环并减少组织损伤。