不同胶体诱导的稀释性凝血障碍可否通过纤维蛋白原和因子 XIII 浓缩物的替代来逆转？
Is dilutional coagulopathy induced by different colloids reversible by replacement of fibrinogen and factor XIII concentrates?
机构信息
From the *Institute of Anesthesiology and †Clinic of Cardiac and Vascular Surgery, University and University Hospital Zurich, Switzerland; ‡Department of Anesthesiology, Metro Health Medical Center, Cleveland, Ohio; and §Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Switzerland.
出版信息
Anesth Analg. 2013 Nov;117(5):1063-71. doi: 10.1213/ANE.0b013e3182a52876.
BACKGROUND
In this in vitro trial, we assessed the effect on blood coagulation of 60% dilution with different colloids and investigated reversibility by replacement of factor XIII (F XIII), fibrinogen, and the combination of fibrinogen and F XIII.
METHODS
Using the blood of 12 volunteers, the following measurements were performed at baseline and after 60% dilution with (hydroxyethyl starch solutions) HES 130/0.42, gelatin, or balanced gelatin solution: blood gas analyses, coagulation factor concentrations (F I, F II, F VII, F VIII, F XIII), impedance aggregometry (Multiplate®), and rotational thromboelastometry (ROTEM). Then F XIII and fibrinogen as well as a combination of both were added, in concentrations corresponding to 6 g fibrinogen and 1250 IU F XIII in adults. ROTEM measurements and determination of factor concentrations were again performed.
RESULTS
Colloid dilution led to a significant reduction of fibrinogen polymerization, especially with HES. Platelet function was impaired by all colloids, with gelatin having a significantly greater effect (area under the curve, collagen Test, P ≤ 0.008) than HES and balanced gelatin solution. The substitution of F XIII only did not improve clot formation. Substitution of fibrinogen improved the polymerization of fibrinogen in dilutions with gelatin and balanced gelatin solution (P = 0.002), whereas HES-induced coagulopathy could not be corrected. The combination of fibrinogen and F XIII showed a better effect than the addition of fibrinogen only for certain variables.
CONCLUSION
Coagulation and platelet function are impaired by all 3 colloids. However, in vitro gelatin-induced coagulopathy was significantly more reversible than HES-induced coagulopathy.
背景
在这项体外试验中，我们评估了不同胶体 60%稀释对凝血的影响，并通过替代因子 XIII（F XIII）、纤维蛋白原以及纤维蛋白原和 F XIII 的组合来研究其逆转性。
方法
使用 12 名志愿者的血液，在基线和用（羟乙基淀粉溶液）HES 130/0.42、明胶或平衡明胶溶液稀释 60%后，进行以下测量：血气分析、凝血因子浓度（F I、F II、F VII、F VIII、F XIII）、阻抗聚集测定（Multiplate®）和旋转血栓弹性测定（ROTEM）。然后，添加 F XIII 和纤维蛋白原以及两者的组合，浓度相当于成人 6 g 纤维蛋白原和 1250 IU F XIII。再次进行 ROTEM 测量和因子浓度测定。
结果
胶体稀释导致纤维蛋白原聚合显著减少，尤其是 HES。所有胶体均损害血小板功能，明胶的作用明显大于 HES 和平衡明胶溶液（曲线下面积，胶原试验，P ≤ 0.008）。仅替代 F XIII 并不能改善凝块形成。纤维蛋白原替代可改善明胶和平衡明胶溶液稀释时纤维蛋白原的聚合（P = 0.002），而 HES 诱导的凝血异常无法纠正。纤维蛋白原和 F XIII 的组合在某些变量上显示出比仅添加纤维蛋白原更好的效果。
结论
所有 3 种胶体均损害凝血和血小板功能。然而，体外明胶诱导的凝血异常比 HES 诱导的凝血异常更具可逆转性。
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