MacDonald R
Anaesthesia. 1977 Jun;32(6):544-53. doi: 10.1111/j.1365-2044.1977.tb10002.x.
The ease with which haemoglobin releases oxygen to the tissues is controlled by erythrocytic 2,3-diphosphoglycerate (2,3-DPG) such that an increase in the concentration of 2,3-DPG decreases oxygen affinity and vice versa. This review article describes the synthesis and breakdown of 2,3-DPG in the Embden-Meyerof pathway in red cells and briefly explains the molecular basis for its effect on oxygen affinity. Interaction of the effects of pH, Pco2, temperature and 2,3-DPG on the oxyhaemoglobin dissociation curve are discussed. The role of 2,3-DPG in the intraerythrocytic adaptation to various types of hypoxaemia is described. The increased oxygen affinity of blood stored in acid-citrate-dextrose (ACD) solution has been shown to be due to the decrease in the concentration of 2,3-DPG which occurs during storage. Methods of maintaining the concentration of 2,3-DPG in stored blood are described. The clinical implication of transfusion of elderly people, anaemic or pregnant patients with ACD stored blood to anaesthetically and surgically acceptable haemoglobin concentrations are discussed. Hypophosphataemia in association with parenteral feeding reduces 2,3-DPG concentration and so increases oxygen affinity. Since post-operative use of intravenous fluids such as dextrose or dextrose/saline also lead to hypophosphataemia, the addition of inorganic phosphorus to routine post-operative intravenous fluid may be advisable. Disorders of acid-base balance effect oxygen affinity not only by the direct effect of pH on the oxyhaemoglobin dissociation curve but by its control of 2,3-DPG metabolism. Management of acid-base disorders and pre-operative aklalinization of patients with sickle cell disease whould take account of this. It is known that anaesthesia alters the position of the oxyhaemoglobin dissociation curve, but it is thought that this is independent of any effects which anaesthetic agents may have on 2,3-DPG concentration. In vitro manipulation of 2,3-DPG concentration with steroids has already been carried out. Elucidation of the role of 2,3-DPG in the control of oxygen affinity may ultimately lead to iatrogenic manipulation of oxygen affinity in vivo.
血红蛋白向组织释放氧气的难易程度受红细胞内2,3 - 二磷酸甘油酸（2,3 - DPG）的控制，使得2,3 - DPG浓度增加会降低氧亲和力，反之亦然。这篇综述文章描述了红细胞中糖酵解途径（Embden - Meyerof pathway）中2,3 - DPG的合成与分解，并简要解释了其影响氧亲和力的分子基础。文中还讨论了pH值、二氧化碳分压、温度和2,3 - DPG对氧合血红蛋白解离曲线影响的相互作用。描述了2,3 - DPG在红细胞内对各种类型低氧血症的适应性作用。已表明储存在酸性枸橼酸盐葡萄糖（ACD）溶液中的血液氧亲和力增加是由于储存过程中2,3 - DPG浓度降低所致。文中介绍了维持储存血液中2,3 - DPG浓度的方法。讨论了将储存于ACD溶液中的血液输注给老年人、贫血或孕妇患者，使其血红蛋白浓度达到麻醉和手术可接受水平的临床意义。与肠外营养相关的低磷血症会降低2,3 - DPG浓度，从而增加氧亲和力。由于术后使用葡萄糖或葡萄糖/盐水等静脉输液也会导致低磷血症，因此在常规术后静脉输液中添加无机磷可能是可取的。酸碱平衡紊乱不仅通过pH值对氧合血红蛋白解离曲线的直接作用，还通过其对2,3 - DPG代谢的控制来影响氧亲和力。镰状细胞病患者酸碱紊乱的管理和术前碱化应考虑到这一点。已知麻醉会改变氧合血红蛋白解离曲线的位置，但人们认为这与麻醉剂对2,3 - DPG浓度可能产生的任何影响无关。已经在体外使用类固醇对2,3 - DPG浓度进行了调控。阐明2,3 - DPG在控制氧亲和力中的作用最终可能导致在体内对氧亲和力进行医源性调控。
