Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
J Trauma Acute Care Surg. 2013 Jul;75(1):129-34. doi: 10.1097/ta.0b013e3182984a9b.
Previous studies have shown large-volume resuscitation modulates coagulopathy and inflammation. Our objective was to analyze the effects of initial bolus fluids used in military and civilian settings on coagulation and inflammation in a prospective, randomized, blinded trial of resuscitation of uncontrolled hemorrhage.
Fifty swine were anesthetized, intubated, and ventilated and had monitoring lines placed. A Grade V liver injury was performed followed by 30 minutes of hemorrhage. After 30 minutes, the liver was packed, and randomized fluid resuscitation was initiated during a 12-minute period with 2 L of normal saline, 2 L of lactated Ringer's solution, 250 mL of 7.5% saline with 3% Dextran, 500 mL of Hextend, or no fluid (NF). Animals were monitored for 2 hours after injury. Thrombelastograms (TEGs), prothrombin time (PT), partial thromboplastin time, fibrinogen as well as serum interleukin 6, interleukin 8, and tumor necrosis factor α levels were drawn at baseline and after 1 hour and 2 hours.
The NF group had less posttreatment blood loss compared with other groups (p < 0.01). Blood loss was similar in the other groups. TEG R values in each group decreased from baseline at 1 and 2 hours (p < 0.02). The groups receiving 2 L of normal saline, 250 mL of 7.5% saline with 3% Dextran, or 500 mL of Hextend had lower TEG maximum amplitude values compared with NF group (p < 0.02). All fluids except lactated Ringer's solution resulted in significant increases in PT compared with NF, whereas all fluids resulted in significant decreases in fibrinogen compared with NF (p < 0.02). Fluid resuscitation groups as well as NF group demonstrated significant increases in inflammatory cytokines from baseline to 1 hour and baseline to 2 hours. There were no significant differences in inflammatory cytokines between groups at 2 hours.
Withholding fluid resulted in the least significant change in PT, fibrinogen, and maximum amplitude and in the lowest posttreatment blood loss. Resuscitation with different initial fluid resuscitation strategies did not result in increased proinflammatory mediators compared with animals that did not receive fluid.
先前的研究表明，大量复苏会调节凝血功能障碍和炎症。我们的目的是在一项对未控制出血进行复苏的前瞻性、随机、盲法试验中，分析军事和民用环境中初始冲击液对凝血和炎症的影响。
50 头猪被麻醉、插管和通气，并放置监测线。进行 5 级肝损伤，随后出血 30 分钟。30 分钟后，用纱布填塞肝脏，并在 12 分钟内随机给予 2 L 生理盐水、2 L 乳酸林格氏液、250 mL 7.5%盐水加 3%右旋糖酐、500 mL Hextend 或不补液（NF）。动物在损伤后 2 小时内进行监测。在基线、1 小时和 2 小时时抽取血栓弹性图（TEG）、凝血酶原时间（PT）、部分凝血活酶时间、纤维蛋白原以及血清白细胞介素 6、白细胞介素 8 和肿瘤坏死因子 α 水平。
NF 组的治疗后出血量明显少于其他组（p<0.01）。其他组之间的出血量相似。每组的 TEG R 值在 1 小时和 2 小时时均低于基线（p<0.02）。与 NF 组相比，接受 2 L 生理盐水、250 mL 7.5%盐水加 3%右旋糖酐或 500 mL Hextend 的组的 TEG 最大振幅值较低（p<0.02）。除乳酸林格氏液外，所有液体与 NF 相比均导致 PT 显著增加，而所有液体与 NF 相比均导致纤维蛋白原显著降低（p<0.02）。与 NF 相比，所有液体复苏组和 NF 组的炎症细胞因子从基线到 1 小时和基线到 2 小时均显著增加。2 小时时各组之间的炎症细胞因子无显著差异。
不补液导致 PT、纤维蛋白原和最大振幅的变化最小，治疗后出血量最低。与未补液的动物相比，不同初始液体复苏策略的复苏并未导致促炎介质的增加。
