Isovolämische Hämodilution mit HAES und bovinem Hämoglobin verbessert die pankreatische MikroZirkulation, den pankreatischen Gewebssauerstoffpartialdruck und bietet einen Überlebensvorteil bei schwerer akuter Pankreatitis im Schweinemodell

Abstract

To avoid the progression from mild edematous acute pancreatitis to the severe necrotising form, one therapeutic option is to improve pancreatic microcirculation. The aim of the study was to evaluate the influence of isovolemic hemodilution and additional oxygen supply (bovine hemoglobin) on pancreatic microcirculation, tissue oxygenation and survival in severe acute experimental (porcine) pancreatitis. Methods: 39 pigs (25 - 30 kg BW) were anesthetised and catheters were placed. After midline laparotomy severe acute pancreatitis was induced (intraducatal injection of glycodeoxycholic acid (0,4 ml/kg BW; 10 mmol/1) and cerulein i.v. (5 microg/kg BW/h)). After 75 minutes animals were randomised into three groups (each n = 13): 1: isovolemic hemodilution (IHD) with hydroxyethyl starch (HES) and additional bovine hemoglobin (Oxyglobin, Biopure, MD); 2: IHD with HES and 3: IHD with Ringer’s solution. Then IHD was started until a hematocrit of 15% (50% of initial hematocrit) was reached. Pancreatic microcirculation was monitored using a laser-doppler scanner (Laser Perfusion Imager, Moor, Millway, UK) and tissue oxygenation of the pancreas (tpO2) was measured using a Licox catheter (GMS, Kiel, FRG). After 6 hours, catheters were removed, the abdomen was closed and animals were extubated. After 6 days, surviving animals were sacrificed. Results: In animals of group 1 pancreatic microcirculation improved over the observational period when compared to group 3 (mean difference of area under the curve: 510,8 (SE 111,5) (p < 0,001). Also, tpO2 improved in HBOC-200 treated animals (102,6 (SE 16,4) vs. group 3 and 76,7 (SE 15,9) vs. group 2; both p < 0,001). Ten animals survived in group 1, while 8 animals in group 2 and only 2 animals in group 3 were alive at the end of the observational period (p = 0,001 Kruskal-Wallis Test). Conclusion: Improved rheology and additional supply of oxygen lead to improved pancreatic microcirculation and better tissue oxygenation in severe acute porcine pancreatitis. This novel therapeutic strategy decreased animal mortality.