聚乙二醇牛血红蛋白偶联物联合右旋糖酐铁对失血性休克模型犬的疗效观察

Efficacy observation of polyethylene glycol-bovine hemoglobin coupling combined with iron dextran on canine hemorrhagic shock model

为了评估聚乙二醇牛血红蛋白偶联物(PEG-bHb)联合右旋糖酐铁对失血性休克犬的治疗效果,试验将12只健康的遵义本地犬随机分为两组,分别为对照组和试验组。两组试验犬经股动脉放血至全血量的40%,休克后,试验组静脉注射PEG-bHb,注射量为失血量×50%,并肌肉注射右旋糖酐铁4 mL;对照组按体重静脉注射生理盐水60 mL/kg。记录术前、休克后、补液后第60,120分钟和第2,3天6个时间点的临床表现、血压[平均动脉压(MAP)、收缩压(SP)和舒张压(DP)]、血氧饱和度(SPO2),以及术前、休克后、补液后(第120分钟和第2,3天)5个时间点的血常规及血清生化指标。结果表明:失血量达40%后试验犬出现昏迷、可视黏膜苍白、流涎、呼吸频率和心率均加快、大小便失禁等症状,与术前比较,休克后试验组和对照组MAP分别降低42%、46%,SPO2分别降低8%、7%,白细胞数(WBC)、红细胞数(RBC)、血细胞比容(HCT)、血红蛋白浓度(HGB)及血小板总数(PLT)全部降低,除肌酐(CREA)含量未见异常外,其余肝脏和肾脏指标均升高。补液后试验组精神状态较对照组好转,甚至恢复至正常状态;补液后第2,3天试验组MAP、DP显著或极显著高于对照组(P<0.05或P<0.01),补液后第3天试验组SP显著高于对照组(P<0.05);补液后第2天,试验组SPO2显著高于对照组(P<0.05),尿素氮(BUN)含量、丙氨酸氨基转移酶(ALT)活性极显著低于对照组(P<0.01),碱性磷酸酶(ALKP)活性显著低于对照组(P<0.05);补液后第120分钟,试验组HGB、PLT极显著高于对照组(P<0.01)。说明PEG-bHb联合右旋糖酐铁有较好的携氧和扩容效果,能够有效控制休克的继续发展。

In order to evaluate the efficacy of polyethylene glycol-bovine hemoglobin coupling(PEG-bHb)combined with iron dextran on canine hemorrhagic shock, In the experiment, 12 healthy local dogs from Zunyi City were randomly divided into two groups, namely the control group and the test group. The test dogs in both groups were bled to 40% of the total blood volume via the femoral artery. After shock, the test group was given intravenous PEG-bHb at a volume of blood loss × 50% and intramuscular iron dextran 4 mL;the control group was given intravenous normal saline 60 mL/kg according to body weights. The clinical manifestations, blood pressure(mean arterial pressure[MAP],systolic blood pressure[SP],diastolic blood pressure[DP]), oxygen saturation(SPO2) were recorded at 6 time points including preoperative, post-shock, 60, 120 min and days 2, 3 after rehydration, and the routine blood, serum biochemical indexes were recorded at 5 time points including preoperative, post-shock, 120 min and days 2, 3 after rehydration. The results showed that after 40% blood loss, the dogs showed signs of coma, pale visual mucosa, salivation, increased respiratory rate and heart rate, and incontinence. Compared to pre-surgery, the after surgery MAP was reduced by 42% and 46%, and oxygen saturation was reduced by 8% and 7% in the test and control groups, respectively;white blood cell count(WBC), red blood cell count(RBC), red blood cell specific volume(HCT), hemoglobin(HGB) and platelet count(PLT) were all reduced;all liver and kidney indexes were increased, except for creatinine(CREA) level, which was normal. Mental status of the test group was better than that of the control group after rehydration, and even returned to the normal state. MAP and DP were significantly or highly significantly higher in the test group than those in the control group on days 2 and 3 after rehydration(P<0.05 or P<0.01). SP was significantly higher in the test group than that in the control group on day 3 after rehydration(P<0.05). On day 2 after rehydration, SPO2was significantly higher in the test group than that in the control group(P<0.05);urea nitrogen(BUN) and alanine aminotransferase(ALT) activities were significantly lower than those in the control group(P<0.01);alkaline phosphatase(ALKP) activities were significantly lower than that in the control group(P<0.05). At 120 min after rehydration, the HGB and PLT of the test group were extremely significantly higher than those of the control group(P<0.01). The results suggested that PEG-bHb combined with iron dextran had better oxygen-carrying and volume expansion effect, which could effectively control the further development of shock.