第3巻 2007年4月　第2号

■原著

出血性ショックに対するliposome-encapsulated hemoglobinが腸管組織酸素代謝に与える影響
小野寺　謙吾¹, 増野　智彦¹, 平川　慶子², 相星　淳一³, 植草　協子², 小池　薫⁴, 大野　曜吉⁵, 山本　保博^1
1日本医科大学大学院医学研究科侵襲生体管理学
²日本医科大学法医学
³東京医科歯科大学救急災害医学
⁴京都大学大学院医学研究科初期診療・救急医学
⁵日本医科大学大学院医学研究科法医学

The Effect of Liposome-Encapsulated Hemoglobin for Intestinal Oxygen Metabolism Following Hemorrhagic Shock
Kengo Onodera¹, Tomohiko Masuno¹, Keiko Hirakawa², Junichi Aiboshi³, Kyoko Uekusa², Kaoru Koike⁴, Youkichi Ohno⁵ and Yasuhiro Yamamoto^1
1Department of Emergency and Critical Care Medicine, Nippon Medical School Graduate School of Medicine
²Department of Legal Medicine, Nippon Medical School
³Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University
⁴Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine
⁵Department of Legal Medicine, Nippon Medical School Graduate School of Medicine

Introduction: Splanchnic hypoperfusion is central to the pathogenesis of acute respiratory dysfunction syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) after hemorrhagic shock (HS), which is a leading cause of morality in patients with severe trauma; however, the underlying mechanism remains unclear. The purpose of this study was to examine whether liposome-encapsulated hemoglobin (LEH) improves oxygen metabolism in rat small intestine after HS.
Methods: HS was induced by withdrawing blood, and mean arterial pressure was maintained at 40 mmHg for 30 minutes. Rats were then resuscitated with shed blood+2 × shed blood volume in normal saline or LEH (equivalent volume to shed blood)+2 × shed blood volume in normal saline over 120 minutes. The small intestines were harvested at four different time points: before HS, after HS, and at 40 and 120 minutes of resuscitation. The tissue levels of lactate and alanine (μmol/g) were measured with ¹H magnetic resonance spectroscopy. Data are expressed as means ± SD and were compared by means of one-way analysis of variance followed by post hoc analysis using Fisher's protected least significant difference (n=5 in each group).
Results: There was no significant difference in hemodynamics between the shed blood and LEH groups. Improvements in intestinal lactate and alanine levels with resuscitation were equivalent in between the shed blood and LEH groups.
Conclusion: LEH appears to have a comparable oxygen carrying capacity to blood and may serve as a useful blood substitute.

日医大医会誌 2007; 3(2), 89-95

Key words
artificial blood, hemorrhagic shock, intestinal ischemia, multiple organ dysfunction syndrome, acute lung injury

Correspondence to
Kengo Onodera, Department of Emergency and Critical Care Medicine, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyou-ku, Tokyo 113-8603, Japan
E-mail：kengoo@nms.ac.jp

受付：2006年12月27日　受理：2007年2月13日