Effekt von bovinem Hämoglobin mit und ohne isovolämische Hämodilution auf die pankreatische Mikrozirkulation, den pankreatischen Gewebssauerstoffpartialdruck und das Überleben bei schwerer akuter Pankreatitis im Schweinemodell

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 bovine haemoglobin with and without additional isovolemic hemodilution on pancreatic microcirculation, tissue oxygenation and survival in severe acute porcine pancreatitis. Methods: 39 pigs (25–30 kg BW) were anesthetised and catheters were placed. After midline laparotomy severe acute pancreatitis was induced (intraductal injection of glycodeoxycholic acid (0,4 ml /kg BW; 10 mmol/l) 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 (HBOC-301, Biopure, MD); 2: application of HES and HBOC-301 without IHD 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, Perimed, Sweden) 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: Induction of the acute pancreatitis led to an initial decrease of tpO2 in all groups irrespective of treatment. Isovolemic hemodilution (IHD) with hydroxyethyl starch and additional bovine hemoglobin as well as application of HES and HBOC-301 without IHD resulted in a significantely improved tissue oxygenation compared to control animals. Ten animals survived in group 1, while 9 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). The extend of histologic tissue damage and the pancreatic microcirculation monitored using the laser-doppler scanner corresponded with these results. Conclusion: The applica-tion of HBOC-301 in combination with IHD as well as application of HES and HBOC-301 without IHD improved pancreatic tissue oxygenation and survival in severe acute porcine pancreatitis. Though, the additional treatment with IHD had no further effect on the monitored parameters.