Creteur Jacques, Vincent Jean-Louis
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Crit Care Med. 2003 Dec;31(12 Suppl):S698-707. doi: 10.1097/01.CCM.0000098037.40520.81.
To review current knowledge about cell-free hemoglobin solutions.
A computerized MEDLINE search was used to retrieve all studies concerning cell-free hemoglobin solutions from 1990 to 2003. The reference lists of all available review articles and primary studies were also reviewed to identify references not identified in the computerized search.
All clinical and experimental studies involving cell-free hemoglobin solutions were included.
From the selected studies, information was obtained regarding the experimental model or the study population in which cell-free hemoglobin solutions were investigated, the type of cell-free hemoglobin solution used, their deleterious or beneficial effects, and their possible indications.
In many studies, hemoglobin solutions were considered as efficient resuscitative agents and good alternatives to red blood cell transfusion, owing to their marked vasopressor effect, coupled with their capacity to improve the microcirculation and rapidly restore metabolic parameters. The main problems identified include excessive systemic vasoconstriction and oxidative damage. Initial enthusiasm in the development of hemoglobin solutions has been tempered recently by the negative results of a U.S. multicenter trial studying the early infusion of diaspirin cross-linked hemoglobin in trauma patients. Nevertheless, the properties of diaspirin cross-linked hemoglobin (and particularly the strong vasopressor effects) cannot be attributed to all hemoglobin solutions, and results of new clinical studies are eagerly awaited to evaluate the potential benefit of such solutions in the management of trauma patients.
Today, we are aware of the effects of the first generation of blood substitutes. Further research is ongoing into newer solutions. One area of interest is the development of new molecular structures to decrease nitric oxide binding, thus minimizing any adverse events and maximizing potential benefits. Nevertheless, possible adverse effects need to be carefully evaluated before these agents can be widely administered.
回顾关于无细胞血红蛋白溶液的现有知识。
利用计算机检索MEDLINE数据库，检索1990年至2003年期间所有关于无细胞血红蛋白溶液的研究。还查阅了所有可得综述文章和原始研究的参考文献列表，以找出计算机检索中未识别的参考文献。
纳入所有涉及无细胞血红蛋白溶液的临床和实验研究。
从选定的研究中，获取有关研究无细胞血红蛋白溶液的实验模型或研究人群、所用无细胞血红蛋白溶液的类型、其有害或有益作用以及可能的适应证等信息。
在许多研究中，血红蛋白溶液因其显著的血管升压作用，以及改善微循环和快速恢复代谢参数的能力，被视为有效的复苏剂和红细胞输血的良好替代品。已确定的主要问题包括过度的全身血管收缩和氧化损伤。最近，美国一项关于创伤患者早期输注双阿司匹林交联血红蛋白的多中心试验的阴性结果，使人们对血红蛋白溶液开发的最初热情有所降温。然而，双阿司匹林交联血红蛋白的特性（尤其是强烈的血管升压作用）不能归因于所有血红蛋白溶液，人们急切期待新的临床研究结果，以评估此类溶液在创伤患者管理中的潜在益处。
如今，我们已了解第一代血液替代品的作用。对更新的溶液的进一步研究正在进行。一个感兴趣的领域是开发新的分子结构以减少一氧化氮结合，从而将任何不良事件降至最低并使潜在益处最大化。然而，在这些药物能够广泛应用之前，需要仔细评估其可能的不良反应。
