Fitzpatrick Colleen M, Biggs Kristen L, Atkins B Zane, Quance-Fitch Fonzie J, Dixon Patricia S, Savage Stephanie A, Jenkins Donald H, Kerby Jeffrey D
Department of Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
J Trauma. 2005 Aug;59(2):273-81; discussion 281-3. doi: 10.1097/01.ta.0000174730.62338.88.
Military guidelines call for two 500-mL boluses of Hextend for resuscitation in far-forward environments. This study compared a hemoglobin-based oxygen carrier (HBOC-201; Hemopure) to Hextend when used to treat hemorrhagic shock in situations of delayed definitive care military operations.
Yorkshire swine (55-65 kg) were hemorrhaged to a mean arterial blood pressure (MAP) of 30 mmHg. Hypotension was maintained for 45 minutes followed by resuscitation with either Hextend (HEX) (n = 8) or HBOC-201 (HBOC) (n = 8). Over 8 hours, animals received up to 1,000 mL of either fluid in an effort to sustain an MAP of 60 mmHg. At the end of 8 hours, HEX animals received 2 L of lactated Ringer's solution followed by shed blood. HBOC animals received 4 L of lactated Ringer's solution only. Animals were killed and necropsied on postprocedure day 5. Hemodynamic data were collected during shock and resuscitation. Complete blood counts, amylase, lactate, coagulation studies, and renal and liver function were measured throughout the experiment.
Equivalent volumes were hemorrhaged from each group (HBOC, 44.3 +/- 2.2 mL/kg; HEX, 47.4 +/- 3.0 mL/kg). The HBOC group achieved the goal MAP (HBOC, 60.0 +/- 2.3 mmHg; HEX, 46.4 +/- 2.3 mmHg; p < 0.01) and required less volume during the initial 8 hours (HBOC, 12.4 +/- 1.4 mL/kg; HEX, 17.3 +/- 0.3 mL/kg; p < 0.01). The HBOC group had lower SvO2 (HBOC, 46.3 +/- 2.4%; HEX, 50.7 +/- 2.5%; p = 0.12) and cardiac output (HBOC, 5.8 +/- 0.4 L/min; HEX, 7.2 +/- 0.6 L/min; p = 0.05), but higher systemic vascular resistance (HBOC, 821.4 +/- 110.7 dynes . s . cm-5; HEX, 489.6 +/- 40.6 dynes . s . cm-5; p = 0.01). Base excess, pH, lactate, and urine output did not differ between groups. HEX group survival was 50% (four of eight) versus 88% for the HBOC group (seven of eight). All animals survived the initial 8 hours. Animals surviving 5 days displayed no clinical or laboratory evidence of organ dysfunction in either group.
HBOC-201 more effectively restored and maintained perfusion pressures with lower volumes, and allowed for improved survival. These data suggest that hemoglobin-based oxygen carriers are superior to the current standard of care for resuscitation in far-forward military operations.
军事指南要求在前沿环境中使用两剂500毫升的贺斯(Hextend)进行复苏。本研究比较了一种基于血红蛋白的氧载体(HBOC-201;Hemopure)与贺斯在军事行动中延迟确定性治疗情况下用于治疗失血性休克时的效果。
将体重55 - 65千克的约克夏猪出血至平均动脉血压(MAP)为30毫米汞柱。维持低血压45分钟,随后用贺斯(HEX)(n = 8)或HBOC-201(HBOC)(n = 8)进行复苏。在8小时内,动物接受多达1000毫升的两种液体中的任何一种,以维持MAP为60毫米汞柱。在8小时结束时,HEX组动物接受2升乳酸林格氏液,随后输入自体失血。HBOC组动物仅接受4升乳酸林格氏液。在术后第5天处死动物并进行尸检。在休克和复苏期间收集血流动力学数据。在整个实验过程中测量全血细胞计数、淀粉酶、乳酸、凝血研究以及肾功能和肝功能。
每组动物的出血量相当(HBOC组,44.3±2.2毫升/千克;HEX组,47.4±3.0毫升/千克)。HBOC组达到了目标MAP(HBOC组,60.0±2.3毫米汞柱;HEX组,46.4±2.3毫米汞柱;p < 0.01),并且在最初8小时内所需液体量更少(HBOC组,12.4±1.4毫升/千克;HEX组,17.3±0.3毫升/千克;p < 0.01)。HBOC组的混合静脉血氧饱和度(SvO2)较低(HBOC组,46.3±2.4%;HEX组,50.7±2.5%;p = 0.12),心输出量也较低(HBOC组,5.8±0.4升/分钟;HEX组,7.2±0.6升/分钟;p = 0.05),但全身血管阻力较高(HBOC组,821.4±110.7达因·秒·厘米⁻⁵;HEX组,489.6±40.6达因·秒·厘米⁻⁵;p = 0.01)。两组之间的碱剩余、pH值、乳酸和尿量没有差异。HEX组的生存率为50%(8只中的4只),而HBOC组为88%(8只中的7只)。所有动物在最初8小时内均存活。存活5天的动物在两组中均未显示出器官功能障碍的临床或实验室证据。
HBOC-201能以更少的液体量更有效地恢复和维持灌注压力,并提高生存率。这些数据表明,在前沿军事行动中,基于血红蛋白的氧载体优于当前的复苏治疗标准。