Burgert James, Gegel Brian, Neal Ann R, Kammer Karl E, Paul Martha E, Schwartz Daniel J, Loughren Michael, Johnson Arthur
Anesthesia Department, Brooke Army Medical Center, 3851 Roger Brooke Drive, San Antonio, TX 78234, USA.
Mil Med. 2012 Mar;177(3):340-4. doi: 10.7205/milmed-d-11-00310.
Uncontrolled bleeding remains the leading cause of preventable death in trauma. Hemostatic agents are effective in hemorrhage control but often fail following high-volume crystalloid resuscitation. Aggressive fluid resuscitation increases the blood pressure which may dislodge the newly formed clot causing rebleeding. The purpose of this study was to determine the systolic blood pressure (SBP) and the mean arterial pressure (MAP) at which rebleeding occurs when a clot is formed by one of these hemostatic agents (BleedArrest, TraumaDex, or Celox) compared to a control group. This was a prospective, experimental study using male 5 Yorkshire swine per group (BleedArrest, TraumaDex, Celox, or control). The femoral artery and vein were transected to simulate a traumatic injury. Subjects were allowed to bleed for 60 seconds then one of the agents was poured into the wound. The control group underwent the same procedures but without the hemostatic agent. After 30 minutes, dressings were removed and the SBP was increased incrementally using intravenous phenylephrine until rebleeding occurred or until the arterial blood pressure reached 210 mm/Hg. The SBP and MAP were significantly higher in the BleedArrest, TraumaDex, and Celox groups compared to a control group (p < 0.05).
失控性出血仍然是创伤中可预防死亡的主要原因。止血剂在控制出血方面有效，但在大量晶体液复苏后往往失效。积极的液体复苏会升高血压，这可能会使新形成的血凝块脱落，导致再次出血。本研究的目的是确定与对照组相比，当使用这些止血剂（BleedArrest、TraumaDex或Celox）之一形成血凝块时发生再次出血的收缩压（SBP）和平均动脉压（MAP）。这是一项前瞻性实验研究，每组使用5只雄性约克郡猪（BleedArrest组、TraumaDex组、Celox组或对照组）。切断股动脉和静脉以模拟创伤性损伤。让受试者出血60秒，然后将其中一种药剂倒入伤口。对照组进行相同的操作，但不使用止血剂。30分钟后，去除敷料，使用静脉注射去氧肾上腺素逐渐升高SBP，直到发生再次出血或动脉血压达到210 mmHg。与对照组相比，BleedArrest组、TraumaDex组和Celox组的SBP和MAP显著更高（p < 0.05）。
