澳大利亚医生用人工合成血液救活失血患者 属世界首例

sunsong7

来源：国际在线 发布时间：2011-5-6 7 U1 v! z; a9 o' R* r
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0 }8 }8 A6 }3 v2 K' j5 X据澳大利亚广播公司、澳大利亚新闻网5月5日综合消息，澳大利亚一名妇女出车祸后失血过多生命垂危，被医生用人工合成血液成功救活，属世界首例。
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! V2 w$ B) Y: N6 E% ?2010年10月，33岁的澳大利亚妇女塔马拉·科克利发生严重车祸，头骨、肋骨、肘部多处骨折，心肺功能衰竭，脾脏破裂，失血过多，生命垂危。在被送往墨尔本的阿尔弗雷德医院后，医护人员发现科克利是一名“耶和华见证人”的信仰者，这一信仰使得她不能接受输血。当时医生断定，科克利活不过24小时。( B: b+ E. s* r0 W, m; i3 @

' p$ [; S- q  N( y就在这时，该院外伤医生马克·菲茨杰拉德忽然想到使用血液替代品——HBOC-2-1(血红蛋白氧载体)，这是一种利用牛的血浆人工合成的血液替代品，由美国军方研制而成的。菲茨杰拉德医生说：“我们想到使用血液替代品，但只有美国才有，而且只有10个单位。在取得联系后，美国方面把10个单位的产品都给了我们。”在输入了替代血液后，科克利的血红蛋白逐渐上升，她渐渐苏醒，如今已经恢复了健康。
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: o5 g5 q6 U% V% }& [% {3 H) i据介绍，菲茨杰拉德医生曾参与了美国的人工合成血液研制，因此对这种产品非常熟悉。他表示，采用人工合成血液救治患者，对于世界性的血液短缺有重要启示。据悉，这种替代血液不需要血型的匹配，不需要冷藏，在常温状态下可以保持3年之久。对于缺乏足够血源的偏远地区而言，这可能是挽救失血患者生命的最佳选择。
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Synthetic blood saves woman's life  c8 K# z2 ]% Q  t- a9 i  C' F/ u
Updated Thu May 5, 2011 10:30am AEST ; G8 m* t& {( _8 H* Z
http://www.abc.net.au/news/stories/2011/05/05/3208136.htm
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& q2 s! Z2 {0 ]$ D- L; X7 U( S% E" FThe synthetic substance is derived from cow's blood. (ABC TV News - file image)
/ U3 \: C% _& I- \" fA doctor who used synthetic blood to save a Victorian woman's life says he is delighted the procedure was successful.
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2 ~9 Z9 g. X: B9 {In an Australian first, 33-year-old Tamara Coakley was given a substance derived from cow's blood after she was seriously injured in a car accident.; Q. [* ~6 n4 f% H

2 w: y; ~" \9 s8 s. m  nAs a Jehovah's Witness, Ms Coakley was unable to have whole blood transfusions but was able to accept substitutes." O: }3 W8 P1 B. \
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Doctors at the Alfred Hospital sourced the blood from the United States. ' z' E  h6 l; q8 X' y# G9 ?  U) `! B
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Trauma doctor Mark Fitzgerald says he tried a number of things to reduce Ms Coakley's blood loss before he thought of using a synthetic product.
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5 k! A. d0 C( z% s9 _8 j9 x"Probably just after 24 hours after she arrived we knew she wasn't going to survive, and then I started sequentially going through a range of options and this is the one we came up with," he said.( s; Z( H2 b" F7 K8 \

) s& I/ C& f. `+ _1 `"At the time we wanted it [the US] only had 10 units available and they gave us all of that product.
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"[We were] just unbelievably lucky."
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Dr Fitzgerald says the product should be made more readily available in Australia.
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% C& ^7 @5 w1 VHe only knew about the existence of the synthetic blood because he had been involved in trials of the product in the US. * x+ J8 n7 _( n2 g
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He says it is not a substitute for the real thing, but could go a long way towards addressing blood bank shortages.
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"Our main interest is to have it available when blood isn't available," he said. # x: \4 A( `! |
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"Blood is the number one choice but there are no options after that. % [" N" P( J9 j1 Z. I2 q) W
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"If you are in a remote area or are isolated, or you don't have access to blood then you don't have any other options."
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Tags: health, blood, australia, vic
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First posted Thu May 5, 2011 7:56am AEST
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amberma

美国于2008年就在J Trauma 2008,64: 1484就发表了对HBOC-201的研究7 r5 U& i2 e( B0 g- Z
当时的研究表明HBOC-201是一种纯化的无细胞的戊二醛+聚合牛血红蛋白+乳酸-林格液。1 B8 Q8 H/ G, o
这种液体可以在室温下存放3年,并且使用时不需要进行交叉配血试验。/ q% H2 ~' P6 b; _3 E0 M
对澳大利亚这个事件有两点疑问：7 t5 N0 \) U; X% q1 Y/ k$ t0 |
一是当时研究HBOC-201会对心脏和中枢神经系统产生影响，不适用于高危病人和年龄大于80岁的病。so想持续关注病人的身体状况……
( C' W3 b' q) |9 t$ A6 G' J二是试验表明低于80岁的病人，在3个单位内才是有效的安全范围。美给了澳10个单位，但此次的用量并未表明。

oldmac7

回复 amberma 的帖子3 i: f' F3 K. N7 P

. w, G- `. l" Z/ l( i; S希望以下的转载能帮到你, 打入十个单位是没问题的:8 E$ m" g+ h! k5 ?* |( X! u, E
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Artificial Blood: HBOC-201 Does Well In Clinical Trial2 ]' X  {) J$ {  |! z4 }3 |% H
By News Staff | June 10th 2008 06:45 PM |
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! [5 l, ?6 u2 uA Phase III multi-center clinical trial of HBOC-201, a hemoglobin-based oxygen carrier, manufactured by Biopure Corporation, was relatively safe in patients under 80 years old who have a moderate need for transfusion, up to the equivalent of three units of regular blood, says a study published in the June edition of the Journal of Trauma.
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This study is the first Phase III trial to compare a blood substitute to regular blood and was conducted at 46 sites in the United States, Europe and South Africa.
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9 Z2 D0 I2 i7 m5 b: \1 T& DThe six-week study involved 688 patients, ages 18 and older, undergoing elective orthopedic surgery, since these procedures often have a high need for blood transfusions. Patients initially received either one unit of blood, which is about a pint, or received an equivalent one unit or 65 grams of HBOC-201.
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- y. y2 \, m2 h& R( ?Made from a bovine source after multiple purifications, HBOC-201 can be kept at room temperature for up to three years and does not need to be matched to one's blood type.
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- [8 `0 Y* {3 t" X5 _Patients could receive up to 10 units of the blood substitute during a six-day period, or for those in the study group receiving regular blood, unlimited transfusions. Subjects were evaluated daily and six weeks post-operatively.1 A; `# l: o$ S& j. k, `; z
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"We found that we eliminated the need for blood transfusions for 59 percent of the 350 patients who received the blood substitute," said Dr. Colin F. Mackenzie, study author, professor and former director, National Study Center for Trauma & EMS, University of Maryland School of Medicine. "The blood substitute worked best in those under 80 years old with a moderate transfusion need."* f+ z/ x, [% p7 R% m
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For those over age 80 with more acute health issues and higher transfusion needs, the blood substitute did not work as well as blood. As a result, many of these patients were crossed over into the group to receive regular blood./ J  R  f9 O9 J) }. q

5 v7 z2 l! T7 h- q6 Y0 B' }8 vA number of adverse events involving the cardiac and central nervous systems were found in 21 of these older patients who received the blood substitute. Analysis revealed that the issues were due to advanced age, heart failure or possibly under-treatment.9 s- u9 W) P( u2 U3 k

4 m/ p. Z: c- F3 b( f7 O9 f"For this specific older acute patient population, we suggest using a blood substitute only if blood is not available. These patients also need to be carefully monitored for vascular volume status and avoidance of fluid overload," said Dr. A. Gerson Greenburg, study author and vice president, medical affairs, Biopure Corporation./ d7 Q5 B5 [: U0 f. ^* b6 v6 t

% P% U: b" o& i. J7 ?6 `: YMortality rates in both study groups with moderate transfusion needs were low -- at one percent. The higher transfusion need groups reported a five percent mortality rate in the blood substitute group and a three percent rate in the group receiving regular blood, which are comparable according to researchers.; ~' G7 O/ k4 W. {

* i2 O5 J6 W: n/ }$ KMany of the less serious adverse effects seen in the overall group receiving the blood substitute were due to temporary expected physiologic effects of this class of drugs which can include skin discoloration interpreted as jaundice, elevation of blood pressure and the rise of levels in the enzymes troponin and lipase.& X! b+ c* L$ d

: ?$ ~9 d2 D5 a6 g+ `"Although these temporary side effects didn't lead to any clinical problems in most patients, these should be studied in future trials," said Jahr.
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% g# k5 E" p( U: A8 g1 `6 MThe majority of the 350 patients in the study arm using the blood substitute received an average of five or less units. A total of 338 patients receiving blood were given less than 2 units on average.: M& ^/ {& d$ m$ ]# F

" L) [7 F% P% ]9 n" G: f* C0 T"This product has a definite place where blood is not an option, such as in patients whose immune system attacks red blood cells or those whose religion forbids blood transfusions and in situations where blood is not available," said Mackenzie.
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" L$ ?! Y4 D! YThe next stage of research will include studies in military and trauma situations and further studies in anemia and ischemia.( r6 A5 @8 s' i+ R
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Biopure, the manufacturer of HBOC-201, funded the study.
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Jahr has served as the principal investigator on one additional Biopure study and owns Biopure stock. He also has been a researcher on other blood substitutes at other companies. Jahr has a large independent lab that has published over 80 manuscripts, reviews and abstracts on blood substitutes independent of any company or company funding. Mackenzie has been a consultant for Biopure and has received funding as a site principal investigator to conduct this study.' I+ P* ^) K' s$ }1 p
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Additional authors include L. Bruce Pearce, Ph.D. and Arkadiy Pitman, Biopure Corporation.

amberma

回复 oldmac7 的帖子
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9 I9 n9 w/ ^5 A7 J0 Z3ks a lot !!!