小容量泊洛沙姆 188 对镇静小型猪严重控制性出血复苏的作用

Severe controlled hemorrhage resuscitation with small volume poloxamer 188 in sedated miniature swine.

机构信息

U.S. Army Institute of Surgical Research, Ft. Sam Houston, TX 78234-6315, USA.

出版信息

Resuscitation. 2011 Nov;82(11):1453-9. doi: 10.1016/j.resuscitation.2011.06.007. Epub 2011 Jul 6.

DOI:10.1016/j.resuscitation.2011.06.007

PMID:21733612

Abstract

BACKGROUND

The surfactant poloxamer 188 (P188) has been shown to improve survival following hemorrhage. This study used P188 as a small volume resuscitation product in a sedated, sexually mature, male miniature swine severe hemorrhage model for potential improvement in rate and time of survival.

METHODS

Fourteen swine were anesthetized, catheterized for hemorrhage and resuscitation and allowed to recover from anesthesia. The animals were sedated and hemorrhaged 60% of estimated blood volume (∼39 mlkg(-1)) exponentially over 1h. Following hemorrhage the animals were treated with either 1.33 mlkg(-1) of P188 (150 mgml(-1); 7 swine) or the P188 citrate vehicle (7 swine) given as an i.v. infusion over 2 min without additional resuscitation fluids. The data were compared with control data from sedated swine similarly hemorrhaged, but with no resuscitation (untreated; n=16).

RESULTS

Median (95% CI) survival time for the untreated control swine was 55.8 (36.5-86) min with a 6% survival at 180 min. Median survival time of 161 (80-180) min for the P188 swine was significantly greater than control (p=0.0186), whereas the citrate vehicle median survival time of 91 (32-180) min was not significantly different from control or P188. At the survival target time of 180 min, survival rates were not significantly different among the three groups. TEG data from swine demonstrated anti-coagulant properties of P188. This was confirmed with human blood ex vivo.

CONCLUSION

In the presence of severe controlled hemorrhage, P188 improved median survival time. However, retardation of blood clotting raises concerns as to its use in the presence of uncontrolled hemorrhage.

摘要

背景

表面活性剂泊洛沙姆 188（P188）已被证明可提高出血后的存活率。本研究在镇静、性成熟的雄性小型猪严重出血模型中，使用 P188 作为小容量复苏产品，以提高存活率和时间。

方法

14 头猪接受麻醉、置管出血和复苏，并从麻醉中恢复。动物镇静并在 1 小时内呈指数级出血 60%的估计血容量（约 39ml/kg）。出血后，用 1.33ml/kg 的 P188（150mg/ml；7 头猪）或 P188 柠檬酸盐载体（7 头猪）以静脉输注 2 分钟的方式治疗，不给予其他复苏液。数据与镇静后同样出血但未接受复苏的猪（未治疗；n=16）的对照数据进行比较。

结果

未治疗对照猪的中位（95%CI）存活时间为 55.8（36.5-86）分钟，180 分钟时存活率为 6%。P188 猪的中位存活时间为 161（80-180）分钟，明显长于对照（p=0.0186），而柠檬酸盐载体的中位存活时间为 91（32-180）分钟，与对照或 P188 无显著差异。在 180 分钟的生存目标时间，三组之间的生存率无显著差异。猪的 TEG 数据表明 P188 具有抗凝血特性。这在人体血液的体外实验中得到了证实。