Noone R B, Mythen M G, Vaslef S N
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Trauma. 1998 Sep;45(3):457-69. doi: 10.1097/00005373-199809000-00006.
Hemoglobin-based blood substitutes may cause vasoconstriction, which could limit organ perfusion during trauma resuscitation. We investigated the effect of two hemoglobin solutions on regional blood flow and mucosal perfusion in the gastrointestinal tract in a hemorrhagic shock model.
Twenty-four swine were bled 30% of blood volume over 1 hour. Six additional animals were anesthetized and monitored but did not undergo hemorrhage. Bled animals were resuscitated with alpha(alpha)-hemoglobin (alpha(alpha)Hb), pyridoxalated hemoglobin polyoxyethylene conjugate (PHP), shed blood, or lactated Ringer's solution. Regional blood flow was measured by radiolabeled microspheres. Gastric mucosal perfusion was estimated by measuring intramucosal pH (pHi) by tonometry.
PHP and shed blood restored small-bowel flows to sham values, whereas lactated Ringer's solution and alpha(alpha)Hb did not. Shed blood and PHP, but not alpha(alpha)Hb, restored cardiac index (CI) to baseline (p < 0.05). Mean pulmonary artery pressure was elevated over baseline with alpha(alpha)Hb and PHP and remained elevated with alpha(alpha)Hb (p < 0.05). pHi was significantly lower after resuscitation with PHP than with other fluids.
PHP was efficacious in restoring CI and small-bowel flow, but the pHi remained low, indicating possible continued mucosal ischemia. Alpha(alpha)Hb led to limited recovery of CI and small-bowel blood flow but restored pHi close to baseline. Shed blood was efficacious in restoration of pHi, gastrointestinal blood flows, and systemic hemodynamics.
基于血红蛋白的血液替代品可能会引起血管收缩，这可能会在创伤复苏期间限制器官灌注。我们在失血性休克模型中研究了两种血红蛋白溶液对胃肠道局部血流和黏膜灌注的影响。
24只猪在1小时内失血30%血容量。另外6只动物进行麻醉和监测，但未经历出血。失血动物用α（α）-血红蛋白（α（α）Hb）、吡哆醛化血红蛋白聚氧乙烯共轭物（PHP）、自体失血或乳酸林格氏液进行复苏。通过放射性标记微球测量局部血流。通过张力测定法测量黏膜内pH值（pHi）来估计胃黏膜灌注。
PHP和自体失血使小肠血流恢复到假手术组水平，而乳酸林格氏液和α（α）Hb则未恢复。自体失血和PHP使心脏指数（CI）恢复到基线水平（p<0.05），而α（α）Hb未恢复。α（α）Hb和PHP使平均肺动脉压高于基线水平，且α（α）Hb时仍保持升高（p<0.05）。用PHP复苏后pHi显著低于其他液体复苏后。
PHP在恢复CI和小肠血流方面有效，但pHi仍较低，表明可能存在持续的黏膜缺血。α（α）Hb导致CI和小肠血流恢复有限，但使pHi恢复至接近基线水平。自体失血在恢复pHi、胃肠道血流和全身血流动力学方面有效。
