Oski F A
Crit Care Med. 1979 Sep;7(9):412-8. doi: 10.1097/00003246-197909000-00013.
Factors responsible for determining the position of the oxyhemoglobin equilibrium curve during the neonatal period are briefly reviewed and the clinical implications of these changes are examined. Two clinical trials employing exchange transfusions as an adjunct to conventional therapy of the severe respiratory distress syndrome have both demonstrated that this procedure reduces mortality. In neither study was it possible to demonstrate that the improvement was a direct consequence of the reduction in hemoglobin's affinity for oxygen that was produced by the substitution of fetal hemoglobin by adult hemoglobin. Data on the role of the position of the oxyhemoglobin equilibrium curve in the regulation of erythropoiesis during the "anemia of prematurity" demonstrate that the ability to unload oxygen is more important than the absolute hemoglobin level in both the stimulus to erythropoietin production and the clinical manifestations of anemia. The gradual shift of the position of the oxyhemoglobin equilibrium curve which occurs during the early months of life may not be sufficient in all infants to meet the growing preterm infants' metabolic needs without evoking additional cardiac compensation.
本文简要回顾了新生儿期决定氧合血红蛋白平衡曲线位置的相关因素，并探讨了这些变化的临床意义。两项采用换血疗法作为重症呼吸窘迫综合征传统治疗辅助手段的临床试验均表明，该操作可降低死亡率。但在这两项研究中，均无法证明病情改善是由于成人血红蛋白替代胎儿血红蛋白导致血红蛋白对氧的亲和力降低的直接结果。关于氧合血红蛋白平衡曲线位置在“早产儿贫血”期间红细胞生成调节中的作用的数据表明，在促红细胞生成素产生的刺激以及贫血的临床表现方面，氧卸载能力比绝对血红蛋白水平更为重要。在生命最初几个月中发生的氧合血红蛋白平衡曲线位置的逐渐变化，可能不足以满足所有婴儿日益增长的代谢需求，而不引发额外的心脏代偿。
