Sloan Edward P, Koenigsberg Max D, Philbin Nora B, Gao Weihua
Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
J Trauma. 2010 May;68(5):1158-71. doi: 10.1097/TA.0b013e3181bbfaac.
Diaspirin cross-linked hemoglobin (DCLHb) has demonstrated a pressor effect that could adversely affect traumatic hemorrhagic shock patients through diminished perfusion to vital organs, causing base deficit (BD) and lactate abnormalities.
Data from two parallel, multicenter traumatic hemorrhagic shock clinical trials from 17 US Emergency Departments and 27 European Union prehospital services using DCLHb, a hemoglobin-based resuscitation fluid.
In the 219 patients, the mean age was 37.3 years, 64% of the patients sustained a blunt injury, 48% received DCLHb resuscitation, and the overall 28-day mortality rate was 36.5%. BD data did not differ by treatment group (DCLHb vs. normal saline [NS]) at any time point. Study entry BD was higher in patients who died when compared with survivors in both studies (US: -14.7 vs. -9.3 and European Union: -11.1 vs. -4.1 mEq/L, p < 0.003) and at the first three time points after resuscitation. No differences in BD based on treatment group were observed in either those who survived or those who died from the hemorrhagic shock. US lactate data did not differ by treatment group (DCLHb vs. NS) at any time point. Study entry lactates were higher in US patients who ultimately died when compared with survivors (82.4 vs. 56.1 mmol/L, p < 0.003) and at all five postresuscitation time points. No lactate differences were observed between DCLHb and NS survivors or in those who died based on treatment group.
Although patients who died had more greatly altered perfusion than those who survived, DCLHb treatment of traumatic hemorrhagic shock patients was not associated with BD or lactate abnormalities that would indicate poor perfusion.
双阿司匹林交联血红蛋白（DCLHb）已显示出升压作用，这可能会通过减少对重要器官的灌注而对创伤性失血性休克患者产生不利影响，导致碱缺失（BD）和乳酸异常。
数据来自两项平行的多中心创伤性失血性休克临床试验，该试验在美国17个急诊科和27个欧盟院前急救服务机构中使用基于血红蛋白的复苏液DCLHb。
在219例患者中，平均年龄为37.3岁，64%的患者为钝性损伤，48%接受DCLHb复苏，总体28天死亡率为36.5%。在任何时间点，BD数据在治疗组（DCLHb与生理盐水[NS]）之间均无差异。在两项研究中，死亡患者的研究入组时BD均高于幸存者（美国：-14.7 vs. -9.3，欧盟：-11.1 vs. -4.1 mEq/L，p < 0.003），以及复苏后的前三个时间点。在存活者或因失血性休克死亡者中，均未观察到基于治疗组的BD差异。美国乳酸数据在任何时间点在治疗组（DCLHb与NS）之间均无差异。最终死亡的美国患者的研究入组时乳酸水平高于幸存者（82.4 vs. 56.1 mmol/L，p < 0.003），以及复苏后的所有五个时间点。在DCLHb和NS幸存者之间或基于治疗组的死亡者中，未观察到乳酸差异。
尽管死亡患者的灌注改变比存活者更大，但DCLHb治疗创伤性失血性休克患者与提示灌注不良的BD或乳酸异常无关。
