Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0412, USA.
Minerva Anestesiol. 2011 Jul;77(7):704-14.
Plasma expanders have become increasingly advantageous when compared to blood transfusion, due to their long shelf-life and cost-effectiveness. A new generation of plasma expander based on polyethylene glycol (PEG) conjugated to human serum albumin (PEG-HSA) has shown positive microvascular effects during extreme hemodilution and fluid resuscitation from severe hemorrhagic shock. PEG conjugation increases uniformly albumin molecular weight (MW) and colloidal osmotic pressure, with minor effects on viscosity.
This study was designed to test the hypothesis that PEG-HSA improves and maintains cardiac function during anemic condition, independently of its lower viscosity, compared to plasma expanders with higher viscosity. To accomplish this objective, we compared PEG-HSA to colloids of different MWs and viscosities, dextran 70 kDa (moderate viscosity plasma expander, MVPE) and dextran 2000 kDa (high viscosity plasma expander, HVPE). Cardiac function was analyzed using indices derived from left ventricular pressure volume, and were assessed using a miniaturized conductance catheter, in two experimental models: 1) hemodilution and 2) resuscitation from hemorrhagic shock.
After hemodilution, PEG-HSA increased cardiac output compared to MVPE through the entire observation period, and HVPE increased stroke work compared to MVPE. After resuscitation, PEG-HSA increased stroke work compared to HVPE through the entire observation period. In both experimental protocols, cardiac functional changes induced by PEG-HSA were sustained over the observation time.
PEG-HSA, a low viscosity plasma expander, had beneficial effects on cardiac function when compared to conventional colloidal plasma expanders with higher viscosities. Maintenance of homeostasis during hemodilution and resuscitation from hemorrhagic shock using PEG-HSA will lead to a significant decrease of the use of blood, thus alleviating in part, forecasted blood shortages, and significantly reducing morbidity and mortality associated with the use of blood in transfusion medicine.
与输血相比，基于聚乙二醇（PEG）与人血清白蛋白（HSA）结合的新一代血浆扩容剂在极端血液稀释和严重失血性休克的液体复苏过程中显示出积极的微血管作用。PEG 缀合均匀增加白蛋白分子量（MW）和胶体渗透压，对粘度的影响较小。
本研究旨在检验以下假设：与粘度较高的血浆扩容剂相比，PEG-HSA 通过降低粘度以外的机制，在贫血状态下改善和维持心脏功能。为了实现这一目标，我们将 PEG-HSA 与不同 MW 和粘度的胶体进行了比较，右旋糖酐 70 kDa（中等粘度的血浆扩容剂，MVPE）和右旋糖酐 2000 kDa（高粘度的血浆扩容剂，HVPE）。使用左心室压力-容积衍生的指数分析心脏功能，并使用微型电导导管在两个实验模型中进行评估：1）血液稀释和 2）失血性休克复苏。
血液稀释后，PEG-HSA 通过整个观察期增加心输出量，与 MVPE 相比，HVPE 通过整个观察期增加每搏功。复苏后，PEG-HSA 通过整个观察期增加每搏功，与 HVPE 相比。在两个实验方案中，PEG-HSA 引起的心脏功能变化在观察时间内持续存在。
PEG-HSA 是一种低粘度的血浆扩容剂，与粘度较高的传统胶体血浆扩容剂相比，对心脏功能有有益的影响。在血液稀释和失血性休克复苏期间使用 PEG-HSA 维持体内平衡将导致血液使用量显著减少，从而在一定程度上缓解预计的血液短缺，并显著降低输血医学中使用血液相关的发病率和死亡率。
