Kao Raymond L C, Xenocostas Anargyros, Rui Tao, Huang Weixiong, Martin Claudio M
Department of National Defense, Canadian Forces Health Services, Ottawa, Ontario, Canada.
J Trauma. 2010 Jun;68(6):1342-8. doi: 10.1097/TA.0b013e3181d27dbe.
Erythropoietin (EPO) can exert acute hemodynamic and anti-inflammatory effects in addition to erythropoiesis. We tested the hypothesis that EPO given at resuscitation with saline will improve capillary perfusion and tissue oxygenation in the gut using a hemorrhagic shock model.
Sprague-Dawley rats were bled 30 mL/kg to maintain a mean arterial blood pressure of 40 mm Hg for 50 minutes and then randomized to one of four resuscitation groups (n = 6 per group): blood, blood + recombinant human EPO (rHuEPO), saline, and saline + rHuEPO. Intravenous rHuEPO (1,000 U/kg) was given at the start of resuscitation. Intravital microscopy was used to measure perfused capillary density, flow motion of red blood cell (RBC), and tissue NADH fluorescence 60 minutes after resuscitation. Venous oxygenation saturation (Svo2) was also measured in a second experiment.
In the blood +/- rHuEPO resuscitation group, the perfused capillary density, RBC flow motion scores, and NADH fluorescence returned to near normal values. The saline + rHuEPO group compared with the saline group demonstrated an increased RBC flow motion score (2.32 vs. 1.60; p < 0.01); however, the perfused capillary density was not significantly increased (23.03 Cap/mm vs. 21.61 Cap/mm; p = 0.40). The saline + rHuEPO group also demonstrated statistically significant lower NADH fluorescence than the saline group after shock following resuscitation (110% +/- 3.64% vs. 122% +/- 4.26%; p < 0.05) suggesting decreased tissue dysoxia. The Svo2 in the saline + rHuEPO group was higher when compared with the saline group (45% vs. 38% by continuous oximetry; 38% vs. 29% by co-oximetry; p < 0.05).
Our results suggest that the addition of rHuEPO at the time of saline resuscitation may have beneficial effects in hemorrhagic shock by improving tissue perfusion and decreasing dysoxia in the gut.
促红细胞生成素（EPO）除了具有促红细胞生成作用外，还可发挥急性血流动力学和抗炎作用。我们使用失血性休克模型，检验了在生理盐水复苏时给予EPO可改善肠道毛细血管灌注和组织氧合的假设。
将Sprague-Dawley大鼠放血30 mL/kg，维持平均动脉血压40 mmHg达50分钟，然后随机分为四个复苏组之一（每组n = 6）：血液、血液+重组人促红细胞生成素（rHuEPO）、生理盐水、生理盐水+rHuEPO。在复苏开始时静脉给予rHuEPO（1000 U/kg）。复苏60分钟后，采用活体显微镜测量灌注毛细血管密度、红细胞（RBC）流动速度和组织NADH荧光。在第二个实验中还测量了静脉氧饱和度（Svo2）。
在血液+/-rHuEPO复苏组中，灌注毛细血管密度、RBC流动速度评分和NADH荧光恢复到接近正常水平。与生理盐水组相比，生理盐水+rHuEPO组的RBC流动速度评分增加（2.32对1.60；p < 0.01）；然而，灌注毛细血管密度未显著增加（23.03个毛细血管/mm对21.61个毛细血管/mm；p = 0.40）。生理盐水+rHuEPO组复苏后休克期的NADH荧光也显著低于生理盐水组（110% +/- 3.64%对122% +/- 4.26%；p < 0.05），提示组织缺氧减轻。与生理盐水组相比，生理盐水+rHuEPO组的Svo2更高（连续血氧测定法为45%对38%；共血氧测定法为38%对29%；p < 0.05）。
我们的结果表明，在生理盐水复苏时添加rHuEPO可能通过改善组织灌注和减轻肠道缺氧，对失血性休克产生有益影响。
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