Cabrales Pedro, Tsai Amy G, Intaglietta Marcos
La Jolla Bioengineering Institute, University of California, San Diego, La Jolla, California 92037, USA.
Shock. 2009 Mar;31(3):300-7. doi: 10.1097/SHK.0b013e318180ff63.
Systemic and microvascular hemodynamic responses to hemorrhagic shock volume resuscitation with hypertonic saline followed by infusion of polymerized bovine hemoglobin (PBH) at different concentrations were studied in the hamster window chamber model to determine the role of plasma oxygen-carrying capacity and vasoactivity during resuscitation. Moderate hemorrhagic shock was induced by arterial controlled bleeding of 50% of blood volume (BV), and a hypovolemic state was maintained for 1 h. Volume was restituted by infusion of hypertonic saline (7.5% NaCl), 3.5% of BV, followed by 10% of BV of PBH at 2 different concentrations. Resuscitation was followed for 90 min and was carried out using 13 gPBH/dL (PBH13), PBH diluted to 4 gPBH/dL in albumin solution at matching colloidal osmotic pressure (PBH4), and an albumin-only solution at matching colloidal osmotic pressure (PBH0). Systemic parameters, microvascular hemodynamics, and functional capillary density were determined during hemorrhage, hypovolemic shock, and resuscitation. The PBH13 caused higher arterial pressure without reverting vasoconstriction and hypoperfusion. The PBH4 and PBH0 had lower MAP and partially reverted vasoconstriction. Only treatment with PBH4 restored perfusion and functional capillary density when compared with PBH13 and PBH0. Blood gas parameters and acid-base balance recovered proportionally to microvascular perfusion. Tissue PO2 was significantly improved in the PBH4 group, showing that limited restoration of oxygen-carrying capacity is beneficial and compensates for the effects of vasoactivity, a characteristic of molecular hemoglobin solutions proposed as blood substitutes.
在仓鼠窗室模型中，研究了对失血性休克进行高渗盐水容量复苏，随后输注不同浓度聚合牛血红蛋白（PBH）时的全身和微血管血流动力学反应，以确定复苏过程中血浆携氧能力和血管活性的作用。通过控制性动脉放血50%血容量（BV）诱导中度失血性休克，并维持低血容量状态1小时。通过输注高渗盐水（7.5%NaCl），占BV的3.5%，随后以2种不同浓度输注占BV 10%的PBH来补充血容量。复苏持续90分钟，使用13 gPBH/dL（PBH13）、在匹配胶体渗透压的白蛋白溶液中稀释至4 gPBH/dL的PBH（PBH4）以及匹配胶体渗透压的仅白蛋白溶液（PBH0）进行。在出血、低血容量休克和复苏过程中测定全身参数、微血管血流动力学和功能性毛细血管密度。PBH13导致较高的动脉压，但未逆转血管收缩和灌注不足。PBH4和PBH0的平均动脉压较低，并部分逆转了血管收缩。与PBH13和PBH0相比，只有PBH4治疗恢复了灌注和功能性毛细血管密度。血气参数和酸碱平衡与微血管灌注成比例恢复。PBH4组的组织PO2显著改善，表明有限恢复携氧能力是有益的，并补偿了血管活性的影响，这是被提议作为血液替代品的分子血红蛋白溶液的一个特征。
