Spoerke Nicholas J, Van Philbert Y, Differding Jerome A, Zink Karen A, Cho S David, Muller Patrick J, Karahan Z Ayhan, Sondeen Jill L, Holcomb John B, Schreiber Martin A
Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
J Trauma. 2010 Nov;69(5):1054-9; discussion 1059-61. doi: 10.1097/TA.0b013e3181f9912a.
Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting. We aimed to determine the effect of RBCs on clotting parameters by comparing resuscitation regimens containing RBCs and plasma with those containing plasma alone.
Thirty-two Yorkshire swine were anesthetized, subjected to a complex model of polytrauma and hemorrhagic shock, and resuscitated with either fresh frozen plasma, lyophilized plasma (LP), or 1:1 ratios of fresh frozen plasma:packed RBC (PRBC) or LP:PRBC. Activated clotting time, prothrombin time, partial thromboplastin time, and thrombelastography (TEG) were performed at 1 hour, 2 hours, 3 hours, and 4 hours after resuscitation.
Animals treated with 1:1 LP:PRBC had less blood loss than the other groups (p < 0.05). The activated clotting time was shorter in the 1:1 groups when compared with the pure plasma groups at all time points (p < 0.05). The 1:1 groups had shorter TEG R times (time to onset of clotting) at 1 hour, 3 hours, and 4 hours compared with pure plasma groups (p < 0.05). Other TEG parameters did not differ between groups. Partial thromboplastin time was shorter in the pure plasma groups than the 1:1 groups at all time points (p < 0.05).
Whole blood assays reveal that RBCs accelerate the onset of clot formation. Coagulation assays using spun plasma underestimate the effect of RBCs on clotting and do not completely characterize clot formation.
出血和凝血功能障碍是创伤后死亡的主要原因。红细胞（RBC）在纠正凝血功能障碍中的作用尚不清楚。目前测量凝血功能障碍的方法可能无法准确描述体内凝血情况。我们旨在通过比较含红细胞和血浆的复苏方案与仅含血浆的复苏方案，来确定红细胞对凝血参数的影响。
将32只约克夏猪麻醉，使其遭受多发伤和失血性休克的复杂模型，并分别用新鲜冰冻血浆、冻干血浆（LP）或新鲜冰冻血浆与浓缩红细胞（PRBC）或LP与PRBC的1:1比例进行复苏。在复苏后1小时、2小时、3小时和4小时进行活化凝血时间、凝血酶原时间、部分凝血活酶时间和血栓弹力图（TEG）检测。
接受1:1 LP:PRBC治疗的动物失血量比其他组少（p < 0.05）。在所有时间点，1:1组的活化凝血时间均短于纯血浆组（p < 0.05）。与纯血浆组相比，1:1组在1小时、3小时和4小时的TEG R时间（凝血开始时间）更短（p < 0.05）。其他TEG参数在组间无差异。在所有时间点，纯血浆组的部分凝血活酶时间均短于1:1组（p < 0.05）。
全血检测显示红细胞可加速凝血形成。使用离心血浆的凝血检测低估了红细胞对凝血的影响，且不能完全描述凝血形成情况。
