Holcomb J B, McClain J M, Pusateri A E, Beall D, Macaitis J M, Harris R A, MacPhee M J, Hess J R
Joint Trauma Training Center, Ben Taub General Hospital, BCM, Houston, USA.
J Trauma. 2000 Aug;49(2):246-50. doi: 10.1097/00005373-200008000-00010.
The majority of early trauma deaths are attributable to uncontrolled hemorrhage from truncal sites. A hemorrhage-control technique that reduced bleeding in the prehospital phase of treatment without requiring manual compression may improve the outcome of these patients. We conducted this preliminary study to determine whether an expanding fibrin sealant foam (FSF) would reduce bleeding from a severe liver injury even during resuscitation.
Rats (n = 31; 291 +/- 5 g; 37.4 +/- 0.3 degrees C; mean +/- SEM), underwent a 60 +/- 5% excision of the median hepatic lobe. The animals received one of three treatments: (1) FSF, (2) immunoglobulin G placebo foam (IgGF), or (3) no treatment. All animals were resuscitated with 40 degrees C lactated Ringer's solution at 3.3 mL/ min/kg to a mean arterial pressure of 100 mm Hg. Total blood loss, mean arterial pressure, and resuscitation volume were recorded for 30 minutes. A qualitative measure of foam coverage and adherence to the cut liver edge was recorded.
The total blood loss was less (p < 0.01) in the FSF group (21.2 +/- 5.0 mL/kg) than in either IgGF (41.4 +/- 4.3 mL/kg) or the no treatment group (44.6 +/- 4.7 mL/kg), which did not differ. The resuscitation volume was not different. The amount of foam used in the treated groups, 9.1 +/- 1.0 g in the FSF group and 10.0 +/- 1.0 g in the IgGF group, did not differ. Survival for 30 minutes was not different among groups. There was no difference in the amount of cut liver covered by either foam, but the clots were more adherent (p < 0.05) in the FSF group than in the IgGF group.
In rats with a severe liver injury, spraying fibrin foam directly on the cut liver surface decreased blood loss when compared with placebo foam and no treatment. This pilot study suggests a future possible treatment for noncompressible truncal hemorrhage.
大多数早期创伤死亡归因于躯干部位无法控制的出血。一种在院前治疗阶段无需手动压迫就能减少出血的止血技术可能会改善这些患者的预后。我们进行了这项初步研究，以确定一种可膨胀的纤维蛋白密封剂泡沫（FSF）是否即使在复苏过程中也能减少严重肝损伤的出血。
大鼠（n = 31；体重291±5 g；体温37.4±0.3℃；平均值±标准误），进行了肝中叶60±5%的切除。动物接受三种治疗之一：（1）FSF，（2）免疫球蛋白G安慰剂泡沫（IgGF），或（3）不治疗。所有动物均用40℃的乳酸林格氏液以3.3 mL/ min/kg的速度复苏至平均动脉压为100 mmHg。记录30分钟内的总失血量、平均动脉压和复苏液量。记录泡沫覆盖和粘附在切开的肝边缘的定性指标。
FSF组（21.2±5.0 mL/kg）的总失血量比IgGF组（41.4±4.3 mL/kg）或未治疗组（44.6±4.7 mL/kg）少（p < 0.01），后两组之间无差异。复苏液量无差异。治疗组使用的泡沫量，FSF组为9.1±1.0 g，IgGF组为10.0±1.0 g，无差异。各组30分钟的存活率无差异。两种泡沫覆盖的切开肝脏量无差异，但FSF组的血凝块比IgGF组更粘附（p < 0.05）。
在严重肝损伤的大鼠中，与安慰剂泡沫和不治疗相比，直接将纤维蛋白泡沫喷洒在切开的肝脏表面可减少出血。这项初步研究表明未来可能有一种治疗不可压缩躯干出血的方法。
