Horn E P, Standl T, Wilhelm S, Jacobs E E, Freitag U, Freitag M, Schulte am Esch J
Abteilung für Anästhesiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Anaesthesist. 1998 Feb;47(2):116-23. doi: 10.1007/s001010050536.
We investigated the effects of ultrapurified polymerized bovine hemoglobin (HBOC-201) on skeletal muscle tissue oxygen tension when applied before establishment of a nearly complete arterial stenosis.
Twelve foxhounds were anaesthetized IV and mechanically ventilated with 30% oxygen in air. Catheters were inserted into the right femoral artery and vein for measurements of haemodynamic parameters and blood-gas sampling. Arterial blood flow of the left popliteal artery was measured by an electromagnetic flow probe. Skeletal muscle tissue oxygen tension (tpo2) was measured in the left gastrocnemic muscle using a stepwise-driven polarographic needle probe, creating histograms from 200 single tpO2 measurements. Following isovolaemic haemodilution with Ringer's solution to a target haematocrit of 20%, the animals were randomly assigned to receive either 200 ml of predonated fresh blood (group 1) or 200 ml of HBOC-201 (MW 32,000-500,000; Hb 13 +/- 1 g-dl-1, group 2). After a 15-min stabilization period, a 95% artificial stenosis of the left popliteal artery was established. While animals of group 1 received two applications of 200 ml 6% hetastarch (HES, 200,000; 0.5), animals of group 2 received 200 ml Ringer's solution 45 and 75 min after establishment of the arterial stenosis, respectively. Variables were measured at baseline, after haemodilution and application of the respective compound, and 30, 60 and 90 min after establishment of the stenosis.
Demographic data, muscle temperature and arterial blood gases did not differ between groups. With the exception of a higher mean pulmonary artery pressure in HBOC-201-treated animals, haemodynamics did not differ between groups. In both groups oxygen delivery and oxygen consumption of the muscle decreased in parallel to the decreasing blood flow during arterial stenosis. In contrast, oxygen extraction ratio increased after infusion of HBOC-201 and remained unchanged during stenosis (P < 0.05). In group 1, the tpO2 decreased during stenosis when compared to baseline (P < 0.001) and remained decreased after administration of HES. In contrast, administration of 200 ml of HBOC-201 before establishment of the arterial stenosis sustained the tpO2 values at nearly baseline levels during stenosis. Skeletal muscle tissue oxygen tension was higher after HBOC-201 infusion during stenosis when compared to HES infusion (P < 0.001).
These data suggest that haemoglobin solutions can reach poststenotic tissues. The increased oxygen extraction after application of HBOC-201 is associated with improved skeletal muscle oxygen tension during severe arterial stenosis.
我们研究了超纯聚合牛血红蛋白（HBOC-201）在建立近乎完全的动脉狭窄之前应用时对骨骼肌组织氧张力的影响。
12只猎狐犬经静脉麻醉，并用含30%氧气的空气进行机械通气。将导管插入右股动脉和静脉，用于测量血流动力学参数和采集血气样本。用电磁流量探头测量左腘动脉的动脉血流量。使用步进驱动极谱针探头在左腓肠肌中测量骨骼肌组织氧张力（tpo2），从200次单次tpO2测量中创建直方图。用林格氏液进行等容血液稀释至目标血细胞比容为20%后，将动物随机分为两组，分别接受200ml预先捐献的新鲜血液（第1组）或200ml HBOC-201（分子量32,000 - 500,000；血红蛋白13±1g·dl-1，第2组）。经过15分钟的稳定期后，建立左腘动脉95%的人工狭窄。第1组动物接受两次200ml 6%羟乙基淀粉（HES，200,000；0.5）输注，第2组动物在动脉狭窄建立后45分钟和75分钟分别接受200ml林格氏液输注。在基线、血液稀释和应用相应化合物后，以及狭窄建立后30、60和90分钟测量各项变量。
两组间人口统计学数据、肌肉温度和动脉血气无差异。除了接受HBOC-201治疗的动物平均肺动脉压较高外，两组间血流动力学无差异。在两组中，动脉狭窄期间肌肉的氧输送和氧消耗均与血流减少平行下降。相比之下，输注HBOC-201后氧摄取率增加，且在狭窄期间保持不变（P < 0.05）。在第1组中，与基线相比，狭窄期间tpO2下降（P < 0.001），给予HES后仍保持下降。相比之下，在动脉狭窄建立前给予200ml HBOC-201可使狭窄期间的tpO2值维持在接近基线水平。与输注HES相比，狭窄期间输注HBOC-201后骨骼肌组织氧张力更高（P < 0.001）。
这些数据表明血红蛋白溶液可到达狭窄后组织。应用HBOC-201后氧摄取增加与严重动脉狭窄期间骨骼肌氧张力改善有关。
