重组凝血因子 VIIa 可有效逆转乳酸酸中毒模型中的凝血功能障碍。

Recombinant factor VIIa is effective at reversing coagulopathy in a lactic acidosis model.

机构信息

Department of Surgery, Madigan Army Medical Center, Tacoma, Washington 98431, USA.

出版信息

J Trauma Acute Care Surg. 2012 Jan;72(1):123-9. doi: 10.1097/TA.0b013e318224e24a.

DOI:10.1097/TA.0b013e318224e24a

PMID:22002618

Abstract

BACKGROUND

The interplay of coagulopathy, acidosis, and hypothermia contributes to the death of the most seriously injured trauma patients. Because of in vitro testing and retrospective series, current recommendations advise correcting acidosis before administering recombinant factor VII (rFVIIa).

METHODS

A lactic acidosis was induced in 40 kg swine, and 10 blood samples were withdrawn for testing. rFVIIa was added to the samples with and without bicarbonate correction of the pH. Conventional coagulation assays as well as rotational thromboelastography (ROTEM) were performed on these in vitro samples. Additionally, 10 acidotic and coagulopathic animals had rFVIIa administered after randomization to pH correction with bicarbonate, or remaining acidotic. Conventional coagulation and ROTEM assays were performed on the animals.

RESULTS

Ex-vivo samples had a mean pH of 7.14 and International Normalized Ratio (INR) of 1.46. Addition of rFVIIa to these samples corrected the INR to 0.98 (p < 0.05). A similar effect was seen for the ROTEM extem Clotting Time (extem CT). Bicarbonate correction alone of these samples had only a modest effect on INR (1.36, p < 0.05). When administered in vivo to acidotic animals (pH, 7.15), rFVIIa lowered the INR from 1.49 to 1.01 (p < 0.05). Similar improvements in extem CT were seen.

CONCLUSIONS

rFVIIa is effective at reversing the coagulopathy from lactic acidosis in a large animal model. Recommendations against its use in acidotic patients may not be valid.

摘要

背景

凝血异常、酸中毒和低体温相互作用导致最严重创伤患者死亡。由于体外检测和回顾性研究，目前的建议建议在给予重组因子 VII（rFVIIa）之前纠正酸中毒。

方法

在 40 公斤的猪中诱导乳酸酸中毒，并抽取 10 份血液样本进行检测。将 rFVIIa 添加到未经 pH 值校正的样本和经碳酸氢盐校正 pH 值的样本中。对这些体外样本进行常规凝血检测和旋转血栓弹性描记术（ROTEM）。此外，在随机分配后，10 只酸中毒和凝血异常的动物给予 rFVIIa，要么进行 pH 值校正，要么保持酸中毒。对动物进行常规凝血和 ROTEM 检测。

结果

离体样本的平均 pH 值为 7.14，国际标准化比值（INR）为 1.46。将 rFVIIa 添加到这些样本中可将 INR 校正至 0.98（p < 0.05）。ROTEM 外凝时间（extem CT）也出现类似效果。单独对这些样本进行碳酸氢盐校正仅对 INR 有适度影响（1.36，p < 0.05）。当将 rFVIIa 给予酸中毒动物（pH 值为 7.15）时，INR 从 1.49 降低至 1.01（p < 0.05）。extem CT 也出现类似改善。