Chappell J E, Shackford S R, McBride W J
Department of Surgery, College of Medicine, University of Vermont, Burlington, USA.
J Neurosurg. 1997 Jan;86(1):131-8. doi: 10.3171/jns.1997.86.1.0131.
Hemodilution has been shown to increase cerebral blood flow (CBF) and reduce lesion volume in models of occlusive cerebral ischemia, but it has not been evaluated in the setting of head trauma and shock in which ischemia is thought to play a role in the evolution of secondary injury. In a porcine model of brain injury and shock the authors compared hemodilution with diaspirin cross-linked hemoglobin (DCLHb) to a standard resuscitation regimen using Ringer's lactate solution and shed blood. After creation of a cryogenic brain injury followed by hemorrhage, the animals received a bolus of either 4 ml/kg of Ringer's lactate solution (Group 1, six animals) or DCLHb (Group 2, six animals), followed by infusion of Ringer's lactate solution to restore mean arterial pressure (MAP) to baseline. Group 1 received shed blood 1 hour after hemorrhage (R1) in the form of packed red blood cells. Group 2 received shed blood only for an Hb count of less than 5 g/dl. The animals were monitored for 24 hours. At R1, Group 2 had a significantly greater cerebral perfusion pressure ([CPP] 88 +/- 5.7 vs. 68 +/- 2.4 mm Hg, p < 0.05). By 3 hours after hemorrhage (R3) Group 2 had a significantly lower Hb concentration (8.5 +/- 0.4 vs. 12.1 +/- 0.3 g/dl, p < 0.05) and a significantly lower intracranial pressure ([ICP] 9 +/- 0.8 vs. 14 +/- 0.6 mm Hg, p < 0.05). The total 24-hour fluid requirement was significantly less in Group 2 (10,654 +/- 505 ml vs. 15,542 +/- 1094 ml, p < 0.05) There was no difference between the groups regarding levels of regional CBF in the injured hemisphere. Cerebral O2 delivery was not significantly different between groups at any time. Lesion volume as determined at postmortem examination was not significantly different between the groups. The increased MAP and CPP and lower ICP observed in the Group 2 animals indicate that hemodilution with DCLHb may be beneficial in the treatment of head injury and shock.
在闭塞性脑缺血模型中，血液稀释已被证明可增加脑血流量（CBF）并减少损伤体积，但尚未在头部创伤和休克的情况下进行评估，在这种情况下，缺血被认为在继发性损伤的演变中起作用。在猪脑损伤和休克模型中，作者将使用双阿司匹林交联血红蛋白（DCLHb）的血液稀释与使用乳酸林格氏液和自体血的标准复苏方案进行了比较。在造成低温性脑损伤并出血后，动物接受4 ml/kg的乳酸林格氏液推注（第1组，6只动物）或DCLHb（第2组，6只动物），随后输注乳酸林格氏液以将平均动脉压（MAP）恢复到基线水平。第1组在出血后1小时（R1）以浓缩红细胞的形式接受自体血。第2组仅在血红蛋白计数低于5 g/dl时接受自体血。对动物进行24小时监测。在R1时，第2组的脑灌注压明显更高（[CPP] 88±5.7 vs. 68±2.4 mmHg，p<0.05）。出血后3小时（R3），第2组的血红蛋白浓度明显更低（8.5±0.4 vs. 12.1±0.3 g/dl，p<0.05），颅内压明显更低（[ICP] 9±0.8 vs. 14±0.6 mmHg，p<0.05）。第2组24小时的总液体需求量明显更少（10,654±505 ml vs. 15,542±1094 ml，p<0.05）。两组间损伤半球的局部CBF水平无差异。两组间在任何时间的脑氧输送均无显著差异。尸检时确定的损伤体积在两组间无显著差异。在第2组动物中观察到的MAP和CPP升高以及ICP降低表明，用DCLHb进行血液稀释可能对头损伤和休克的治疗有益。
