不同血浆代用品对严重急性等容血液稀释大鼠的影响。

Effects of different plasma expanders on rats subjected to severe acute normovolemic hemodilution.

机构信息

Institute of Health Service and Transfusion Medicine, Bejing, 100850, China.

出版信息

Mil Med Res. 2020 Nov 11;7(1):55. doi: 10.1186/s40779-020-00282-4.

DOI:10.1186/s40779-020-00282-4

PMID:33172500

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7656672/

Abstract

BACKGROUND

Plasma expanders are widely used for acute normovolemic hemodilution (ANH). However, existing studies have not focused on large-volume infusion with colloidal plasma expanders, and there is a lack of studies that compare the effects of different plasma expanders.

METHODS

The viscosity, hydrodynamic radius (R) and colloid osmotic pressure (COP) of plasma expanders were determined by a cone-plate viscometer, Zetasizer and cut-off membrane, respectively. Sixty male rats were randomized into five groups with Gelofusine (Gel), Hydroxyethyl Starch 200/0.5 (HES200), Hydroxyethyl Starch 130/0.4 (HES130), Hydroxyethyl Starch 40 (HES40), and Dextran40 (Dex40), with 12 rats used in each group to build the ANH model. ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders. Acid-base, lactate, blood gas and physiological parameters were detected.

RESULTS

Gel had a lower intrinsic viscosity than HES200 and HES130 (P < 0.01), but at a low shear rate in a mixture of colloids, red cells and plasma, Gel had a higher viscosity (P < 0.05 or P < 0.01, respectively). For hydroxyethyl starch plasma expanders, the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of R from 10.7 nm to 20.2 nm. A severe ANH model, with the hematocrit of 40% of the baseline level, was established and accompanied by disturbances in acid-base, lactate and blood gas parameters. At the end of ANH and 60 min afterward, the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) decreased significantly in all groups at the end of ANH. The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH. During the process of ANH, the Dex40 group showed a drop and recovery in SBP, DBP and MAP. The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points (P < 0.05 or P < 0.01).

CONCLUSION

Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates. R and COP showed a strong correlation among hydroxyethyl starch plasma expanders. Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders. During the process of ANH, Dex40 displayed a V-shaped recovery pattern for blood pressure, and HES200 had the advantage in sustaining the DBP and MAP at some time points.

摘要

背景

血浆代用品广泛应用于急性等容血液稀释（ANH）。然而，现有的研究并未关注胶体血浆代用品的大容量输注，也缺乏对不同血浆代用品效果的比较研究。

方法

采用锥板粘度计、Zetasizer 和截止膜分别测定血浆代用品的粘度、水动力半径（R）和胶体渗透压（COP）。将 60 只雄性大鼠随机分为 5 组，分别为 Gelofusine（Gel）、羟乙基淀粉 200/0.5（HES200）、羟乙基淀粉 130/0.4（HES130）、羟乙基淀粉 40（HES40）和 Dextran40（Dex40），每组 12 只大鼠用于建立 ANH 模型。通过抽血和同时输注血浆代用品进行 ANH。检测酸碱、乳酸、血气和生理参数。

结果

Gel 的固有粘度低于 HES200 和 HES130（P<0.01），但在胶体、红细胞和血浆混合物的低剪切率下，Gel 的粘度较高（P<0.05 或 P<0.01，分别）。对于羟乙基淀粉血浆代用品，在一定浓度下，COP 从 11.1mmHg 降低到 6.1mmHg，随着 R 从 10.7nm 增加到 20.2nm。建立了严重的 ANH 模型，红细胞比容降低至基线水平的 40%，伴有酸碱、乳酸和血气参数的紊乱。在 ANH 结束时和结束后 60 分钟，与其他组相比，Dex40 组在维持酸碱平衡和全身氧合方面的效果更差。在 ANH 结束时，所有组的收缩压（SBP）、舒张压（DBP）和平均动脉压（MAP）均显著降低。在 ANH 结束后 60 分钟，Dex40 组的 DBP 和 MAP 进一步下降。在 ANH 过程中，Dex40 组的 SBP、DBP 和 MAP 呈下降和恢复趋势。在某些时间点，HES200 组的 DBP 和 MAP 明显高于其他组（P<0.05 或 P<0.01）。

结论

Gel 的固有粘度较低，但在低剪切率下可能会增加全血粘度。R 和 COP 之间存在很强的相关性，羟乙基淀粉血浆代用品。与其他血浆代用品相比，Dex40 组在维持酸碱平衡和全身氧合方面的效果较差。在 ANH 过程中，Dex40 组的血压呈 V 型恢复模式，HES200 组在某些时间点具有维持 DBP 和 MAP 的优势。