血红蛋白氧载体对非控制性失血性休克大鼠早期复苏效果的影响  

Beneficial effects of hemoglobin-based oxygen carriers on early resuscitation in rats with uncontrolled hemorrhagic shock

作　　者：朱娱[1] 张杰[1] 吴跃[1] 田昆仑[1] 彭小勇[1] 向鑫明 刘良明[1] 李涛[1] Zhu Yu;Zhang Jie;Wu Yue;Tian Kunlun;Peng Xiaoyong;Xiang Xinming;Liu Liangming;Li Tao(State Key Laboratory of Trauma,Burn and Combined Injury,Institute of Surgery,Research,Daping Hospital of Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院野战外科研究所,创伤、烧伤与复合伤国家重点实验室,重庆400042

出　　处：《中华危重病急救医学》2019年第1期81-86,共6页Chinese Critical Care Medicine

基　　金：全军“十三五”重大项目(AWS16J032).

摘　　要：目的观察血红蛋白氧载体(HBOC)对非控制性失血性休克大鼠的早期复苏效果。方法将170只SD大鼠按随机数字表法分为乳酸林格液(LR)对照组、全血对照组及0.5%、2.0%、5.0%HBOC组,每组34只。采用离断脾动脉方法使平均动脉压(MAP)降至40mmHg(1mmHg=0.133kPa)制备非控制性失血性休克大鼠模型。各组分别于制模成功后输注相应液体,维持MAP在50mmHg1h,然后结扎脾动脉彻底止血,再次输注液体,维持MAP70mmHg和80mmHg各1h,在维持MAP80mmHg输注液体完毕后,均用LR补充至2倍失血量,再继续观察2h。各组分别取16只大鼠用于观察存活率和失血率;再取10只大鼠用于测定血流动力学指标〔MAP、左室收缩压(LVSP)和左室压力上升最大速率(+dp/dtmax)〕;另外8只大鼠用于测定心排血量(CO)和组织氧供(DO2)。结果①单纯采用LR复苏时,动物失血率高达60%~70%。与LR对照组比较,全血复苏可显著降低非控制性失血性休克大鼠止血前失血率〔(46.6±4.5)%比(62.3±4.0)%,P<0.01〕;0.5%、2.0%、5.0%HBOC复苏也可显著降低失血率,以5.0%HBOC组降低更为显著,与LR对照组比较差异有统计学意义〔(45.6±4.1)%比(62.3±4.0)%,P<0.01〕。②单纯采用LR复苏时,大鼠死亡较快,存活时间短,12h仅存活1只,没有大鼠存活超过24h。与LR对照组比较,全血复苏可提高非控制性失血性休克大鼠存活率,且存活时间明显延长(h:20.4±4.6比3.5±1.1,P<0.01);0.5%、2.0%、5.0%HBOC也可显著延长大鼠存活时间,以5.0%HBOC组效果最好,24h存活4只,存活时间较LR对照组明显延长(h:18.4±4.0比3.5±1.1,P<0.01),且与全血对照组相当。③与休克前比较,非控制性失血性休克大鼠CO、DO2和血流动力学指标均显著降低;随补液时间延长,各组上述指标均逐渐升高。与LR对照组比较,全血复苏可明显提高非控制性失血性休克大鼠各时间点CO、DO2,改善血流动力学;3个浓度HBOC也可提高止血后维持MAP80mmHg1h及复苏后1h�Objective To investigate the early resuscitation effect of hemoglobin-based oxygen carriers (HBOC) in rats with uncontrolled hemorrhagic shock. Methods 170 Sprague-Dawley (SD) rats were randomly divided into five groups: lactate Ringer solution (LR) control group, whole blood control group, and 0.5%, 2.0%, 5.0% HBOC groups, with 34 rats in each group. The uncontrolled hemorrhagic shock model in SD rats was reproduced by cutting off the splenic artery branch, and induced mean arterial pressure (MAP) reducing to 40 mmHg (1 mmHg = 0.133 kPa). The corresponding solution was infused after model reproduction in each group, maintaining MAP at 50 mmHg for 1 hour, then completely ligating and hemostasis, and maintaining MAP at 70 mmHg for 1 hour and 80 mmHg for 1 hour respectively, after maintaining MAP 80 mmHg, all were supplemented with LR to 2 times blood loss volume. The survival rate and blood loss rate were observed in 16 rats in each group, hemodynamics parameters including MAP, left ventricular systolic pressure (LVSP) and the maximum rate of left ventricular pressure rise (+dp/dtmax) were determined in another 10 rats, and cardiac output (CO) and tissue oxygen supply (DO2) were observed in the rest 8 rats. Results ① When resuscitation by LR alone, the blood loss rate of animals was as high as 60% to 70%. Compared with the LR control group, whole blood recovery could significantly reduce the blood loss rate before hemostasis in uncontrolled hemorrhagic shock rats [(46.6±4.5)% vs. (62.3±4.0)%, P < 0.01];0.5%, 2.0%, 5.0% HBOC could significantly decrease the blood loss rate, especially in 5.0% HBOC group with significant difference as compared with that in the LR control group [(45.6±4.1)% vs. (62.3±4.0)%, P < 0.01]. ② When LR was used alone for resuscitation, the rats died quickly and survived for a short time. Only one rat survived for 12 hours, and no rat survived for more than 24 hours. Compared with the LR control group, whole blood resuscitation could improve the survival rate of uncontrolled hemorrhag

关 键 词：血红蛋白氧载体 创伤 失血性休克 大鼠 

分 类 号：R459.7[医药卫生—急诊医学]