Wirk Shaheen, Vaslef Steven N
Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
Arch Surg. 2004 Jan;139(1):55-60. doi: 10.1001/archsurg.139.1.55.
Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP), a hemoglobin-based oxygen carrier, is effective in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage but may be less effective in off-loading oxygen at the tissue level.
Before-after trial.
Animal research laboratory of an academic institution.
Ten female Yorkshire swine.
Anesthetized swine underwent a 25% controlled hemorrhage followed by resuscitation with crystalloid plus either shed blood or PHP. Hemodynamic parameters, including heart rate, mean arterial pressure, mean pulmonary arterial pressure, and cardiac index were continuously monitored. Arterial and mixed venous blood samples were collected at baseline, after hemorrhage, after resuscitation, and every 15 minutes for 90 minutes after resuscitation. Oxygen delivery and consumption, oxygen extraction ratios, and percentage of contribution to oxygen delivery and consumption were determined in whole blood, red blood cells, and plasma by using a compartmentalized approach.
Intergroup and intragroup comparisons were performed for hemodynamic parameters and oxygen transport dynamics.
Heart rate returned closer to baseline levels in the PHP group (P<.05) and mean pulmonary arterial pressure was transiently elevated after infusion of PHP (P =.028), but otherwise no significant differences in hemodynamic balance were observed. The extraction ratio from the red blood cells in the PHP group more than doubled, whereas the extraction ratio from plasma remained constant. The percentage of contribution of plasma, including PHP, to oxygen delivery exceeded 20% (P <.05), but the relative contribution to oxygen consumption did not markedly change from baseline.
Pyridoxalated hemoglobin polyoxyethylene conjugate is at least as effective as shed blood in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage. There is a disproportionately low contribution from plasma to oxygen consumption, which suggests that PHP may act as an oxygen sink in moderate anemia.
吡哆醛化血红蛋白聚氧乙烯共轭物（PHP），一种基于血红蛋白的氧载体，在中度出血后恢复血流动力学平衡和氧输送方面有效，但在组织水平卸载氧方面可能效果较差。
前后试验。
一所学术机构的动物研究实验室。
十只雌性约克夏猪。
对麻醉的猪进行25%的控制性出血，然后用晶体液加自体失血或PHP进行复苏。持续监测血流动力学参数，包括心率、平均动脉压、平均肺动脉压和心脏指数。在基线、出血后、复苏后以及复苏后90分钟内每15分钟采集动脉和混合静脉血样。采用分区法测定全血、红细胞和血浆中的氧输送和消耗、氧提取率以及对氧输送和消耗的贡献百分比。
对血流动力学参数和氧运输动力学进行组间和组内比较。
PHP组心率恢复到更接近基线水平（P<.05），输注PHP后平均肺动脉压短暂升高（P =.028），但在血流动力学平衡方面未观察到其他显著差异。PHP组红细胞的提取率增加了一倍多，而血浆的提取率保持不变。包括PHP在内的血浆对氧输送的贡献百分比超过20%（P <.05），但对氧消耗的相对贡献与基线相比没有明显变化。
吡哆醛化血红蛋白聚氧乙烯共轭物在中度出血后恢复血流动力学平衡和氧输送方面至少与自体失血一样有效。血浆对氧消耗的贡献比例过低，这表明PHP在中度贫血中可能起到氧汇的作用。
