Anesthesiology：吸入一氧化氮或改善输血后小鼠的预后情况

2012年11月23日--近日，刊登在国际杂志Anesthesiology上的一篇研究报告指出，一氧化氮的吸入可以降低小鼠因输血所引发的副作用，来自国外的研究者发现，一氧化氮的吸入可以降低组织损伤以及改善失血性休克后输血小鼠的短期生存率。

长时间的输血和发病率、死亡率风险升高直接相关，尤其是对于心血管疾病患者，机体中储存的血液可以降低转运氧气的能力，而且在输血之后很多都会由于血管中的一氧化氮而被破坏。尽管输血可以帮助病人，但是当输血前，如果红细胞储存了很长时间，就会对使得病人更加虚弱。

这项研究中，研究者发现，当小鼠在输血期间和输血后呼吸一氧化氮时，其可以降低小鼠的组织损伤，降低乳酸盐水平以及减小炎症发生和氧化压力的损伤。同样，一氧化氮的吸入可以改善高脂肪膳食小鼠的短期生存率（这种小鼠在输血后复活了）。

通过输血复活的小鼠会负面影响其出血性休克小鼠的预后结果，而且这种反应会随着高脂肪膳食的摄入使得小鼠的病情更加恶化，研究者表示，他们的研究确定了输血对于糖尿病或过重小鼠是有害的，而且储存血液对于小鼠的危害可以通过吸入一氧化氮来预防和阻止。这项研究将帮助研究者更好地鉴别那些输血后对副作用非常敏感的病人，而且对于治疗病人的疾病提供了新的思路。

与输血相关的拓展阅读：

• Medscape：消化道出血的输血治疗：Less Is More
• Ann Surg：直肠癌根治性切除术前输血不影响患者生存率
• Lancet:术前输血可降低镰状细胞病围手术期并发症
• NEJM：消化道出血患者采用限制性输血策略更具优势
• ARCH INTERN MED:输血增心梗患者死亡风险 更多信息请点击：有关输血更多资讯

Inhaled Nitric Oxide Attenuates the Adverse Effects of Transfusing Stored Syngeneic Erythrocytes in Mice with Endothelial Dysfunction after Hemorrhagic Shock

Background: The authors investigated whether transfusion with stored erythrocytes would increase tissue injury, inflammation, oxidative stress, and mortality (adverse effects of transfusing stored erythrocytes) in a murine model of hemorrhagic shock. They tested whether the adverse effects associated with transfusing stored erythrocytes were exacerbated by endothelial dysfunction and ameliorated by inhaling nitric oxide. Methods: The authors studied mice fed a high-fat diet (HFD-fed; to induce endothelial dysfunction) or a standard diet for 4–6 weeks. Mice were subjected to 90 min of hemorrhagic shock, followed by resuscitation with leukoreduced syngeneic erythrocytes stored less than 24 h (fresh erythrocytes) or stored for 2 weeks (stored erythrocytes). Results: In standard-diet–fed mice at 2 h after resuscitation, transfusion with stored erythrocytes increased tissue injury more than transfusion with fresh erythrocytes. The adverse effects of transfusing stored erythrocytes were more marked in HFD-fed mice and associated with increased lactate levels and short-term mortality. Compared with fresh erythrocytes, resuscitation with stored erythrocytes was associated with a reduction in P50, increased plasma hemoglobin levels, and increased indices of inflammation and oxidative stress, effects that were exacerbated in HFD-fed mice. Inhaled nitric oxide reduced tissue injury, lactate levels, and indices of inflammation and oxidative stress and improved short-term survival in HFD-fed mice resuscitated with stored erythrocytes. Conclusions: Resuscitation with stored erythrocytes adversely impacts outcome in mice with hemorrhagic shock, an effect that is exacerbated in mice with endothelial dysfunction. Inhaled nitric oxide reduces tissue injury and improves short-term survival in HFD-fed mice resuscitated with stored erythrocytes.