Simoni J, Simoni G, Newman G, Feola M
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock 79430, USA.
ASAIO J. 1996 Sep-Oct;42(5):M773-82.
The purpose of the present study was to assess the ability of an improved free hemoglobin based blood substitute to serve as a resuscitative fluid in the treatment of hemorrhagic shock. Comparison studies were performed by using blood autotransfusion as a positive control. The hemodynamic parameters studied included cardiac index, mean arterial pressure, pulse pressure, heart rate, stroke volume index, and total peripheral resistance. Tissue oxygenation was measured in the biceps femori muscle by polarography. Hemorrhagic shock (at 40% of the total blood volume) in anesthetized rats caused severe disturbances in hemodynamic parameters and tissue oxygenation. Shock was characterized by a 66% drop in cardiac index, a 67% drop in mean arterial pressure with a significant increase in total peripheral resistance, and a 78% reduction in tissue oxygenation, all lasting 30 min. Resuscitation from shock with the blood substitute was effective in restoring hemodynamic parameters, producing vasodilation, and improving tissue oxygenation. Autotransfusion with blood also restored hemodynamics. However, lower tissue oxygenation and lack of vasodilation were noted. Therefore, the modified hemoglobin solution yielded better results than blood in the resuscitation of rats after hemorrhagic shock. The vasodilatory activity and the reduction of vasoconstriction that followed hemorrhage can be primarily linked with adenosine, which possesses vasodilatory and anti-inflammatory properties, and is used in our technology as an intermolecular cross linking reagent and hemoglobin surface modifier.
本研究的目的是评估一种改良的基于游离血红蛋白的血液替代品在治疗失血性休克时作为复苏液的能力。通过使用自体输血作为阳性对照进行比较研究。所研究的血流动力学参数包括心脏指数、平均动脉压、脉压、心率、每搏量指数和总外周阻力。通过极谱法测量股二头肌的组织氧合。麻醉大鼠的失血性休克（失血占总血容量的40%）导致血流动力学参数和组织氧合严重紊乱。休克的特征是心脏指数下降66%，平均动脉压下降67%，总外周阻力显著增加，组织氧合减少78%，所有这些情况持续30分钟。用血液替代品进行休克复苏可有效恢复血流动力学参数、产生血管舒张并改善组织氧合。自体输血也能恢复血流动力学。然而，观察到组织氧合较低且缺乏血管舒张。因此，在失血性休克大鼠的复苏中，改良血红蛋白溶液比血液产生了更好的效果。出血后随之出现的血管舒张活性和血管收缩的减轻主要与腺苷有关，腺苷具有血管舒张和抗炎特性，在我们的技术中用作分子间交联试剂和血红蛋白表面改性剂。
