Winslow R M, Gonzales A, Gonzales M L, Magde M, McCarthy M, Rohlfs R J, Vandegriff K D
Department of Medicine, School of Medicine, University of California, San Diego, and Department of Veterans Affairs Medical Center, San Diego, California 92161, USA.
J Appl Physiol (1985). 1998 Sep;85(3):993-1003. doi: 10.1152/jappl.1998.85.3.993.
We have compared polyethylene glycol-modified bovine hemoglobin (PEG-Hb; high O2 affinity, high viscosity, high oncotic pressure) and human hemoglobin cross-linked between the alpha-chains (alpha alpha-Hb; low O2 affinity, low viscosity, low oncotic pressure) with a non-O2-carrying plasma expander (pentastarch, high viscosity and oncotic pressure) after a 50% (by volume) exchange transfusion followed by a severe (60% of blood volume) hemorrhage. Mean arterial pressure and systemic vascular resistance rose significantly in the alpha alpha-Hb but not in the PEG-Hb animals. Two-hour survival was greater in the PEG-Hb animals (93%) than in control (35%), pentastarch (8%), or alpha alpha-Hb (6%) animals. In the PEG-Hb animals, there was no disturbance of acid-base balance, significantly less accumulation of lactic acid, and higher cardiac output than in the other groups. The data suggest that the rise in vascular resistance that follows alpha alpha-Hb exchange transfusion offsets the additional O2 transport provided by the cell-free hemoglobin. When resistance does not rise, as with PEG-Hb, even relatively small amounts of cell-free hemoglobin appear to be a very effective blood replacement.
我们比较了聚乙二醇修饰的牛血红蛋白（PEG-Hb；高氧亲和力、高粘度、高胶体渗透压）和α链间交联的人血红蛋白（αα-Hb；低氧亲和力、低粘度、低胶体渗透压）与一种非携氧血浆扩容剂（万汶，高粘度和胶体渗透压）在进行50%（按体积计）换血输血后再发生严重（血容量的60%）出血的情况。αα-Hb组动物的平均动脉压和全身血管阻力显著升高，而PEG-Hb组动物则未出现这种情况。PEG-Hb组动物的两小时生存率（93%）高于对照组（35%）、万汶组（8%）或αα-Hb组（6%）动物。与其他组相比，PEG-Hb组动物的酸碱平衡未受干扰，乳酸积累显著较少，心输出量较高。数据表明，αα-Hb换血输血后血管阻力的升高抵消了无细胞血红蛋白所提供的额外氧运输。当阻力不升高时，如PEG-Hb的情况，即使相对少量的无细胞血红蛋白似乎也是一种非常有效的血液替代品。
