不同凝血因子、凝血酶生成和凝血功能在猪失血性休克后的恢复特征。

Different recovery profiles of coagulation factors, thrombin generation, and coagulation function after hemorrhagic shock in pigs.

机构信息

US Army Institute of Surgical Research, Ft Sam Houston, San Antonio, Texas 78234, USA.

出版信息

J Trauma Acute Care Surg. 2012 Sep;73(3):640-7. doi: 10.1097/TA.0b013e318253b693.

DOI:10.1097/TA.0b013e318253b693

PMID:22710770

Abstract

BACKGROUND

Hemorrhagic shock contributes to coagulopathy after trauma. We investigated daily changes of coagulation components and coagulation function for 5 days in hemorrhaged and resuscitated pigs.

METHODS

Fourteen pigs were randomized into the sham control (C) and the hemorrhage and lactated Ringer's resuscitation (H-LR) groups. On day 1, hemorrhage was induced in the H-LR group by bleeding 35% of the total blood volume, followed by LR resuscitation at three times the bled volume. Pigs in the C group were not hemorrhaged or resuscitated. Hemodynamics and coagulation were measured daily after H-LR on day 1 to day 5.

RESULTS

No changes in hemodynamics and coagulation function occurred in C. Hemorrhage decreased mean arterial pressure and increased heart rate. LR resuscitation corrected these changes within 2 hours. Compared with the baseline values (BL) on day 1, fibrinogen levels were decreased to 76% ± 6% by H-LR on day 1, increased to 217% ± 16% on day 2, and remained increased thereafter; platelet counts were decreased to 63% ± 5% by H-LR on day 1 and remained lower on days 2 and 3 but returned to BL by days 4 and 5 (all p < 0.05). Thrombin generation was decreased by H-LR on days 1 and 2 but then increased to above BL on days 4 and 5. Coagulation factor levels were decreased by H-LR on day 1 but returned to BL on day 3 except for factor XIII. Clot strength was decreased by H-LR on day 1 and returned to BL by day 2. Clot rapidity did not change on day 1 but was decreased on days 2 and 3 and returned to BL on days 4 and 5.

CONCLUSION

Hemorrhage and resuscitation reduced coagulation components and compromised coagulation function, which showed different recovery profiles over the 5-day study period.

摘要

背景

出血性休克可导致创伤后凝血障碍。我们研究了出血和复苏后的猪在 5 天内凝血成分和凝血功能的日变化。

方法

14 头猪随机分为假手术对照（C）组和出血加乳酸林格液复苏（H-LR）组。在 H-LR 组的第 1 天，通过出血 35%的总血容量诱导出血，然后用出血体积的三倍进行 LR 复苏。C 组的猪未出血或复苏。在第 1 天至第 5 天每天在 H-LR 后测量血流动力学和凝血情况。

结果

C 组的血流动力学和凝血功能无变化。出血降低平均动脉压并增加心率。LR 复苏在 2 小时内纠正了这些变化。与第 1 天的基线值（BL）相比，纤维蛋白原水平在第 1 天的 H-LR 后降低至 76%±6%，第 2 天增加至 217%±16%，此后一直升高；血小板计数在第 1 天的 H-LR 后降低至 63%±5%，第 2 天和第 3 天仍较低，但在第 4 天和第 5 天恢复至 BL（均 P<0.05）。第 1 天和第 2 天的 H-LR 降低了凝血酶生成，但随后在第 4 天和第 5 天增加到 BL 以上。凝血因子水平在第 1 天的 H-LR 后降低，但在第 3 天恢复到 BL，除了因子 XIII。第 1 天的 H-LR 降低了血栓强度，第 2 天恢复到 BL。第 1 天的血栓速度没有变化，但在第 2 天和第 3 天降低，并在第 4 天和第 5 天恢复到 BL。