From the Division of Trauma, Emergency Surgery and Surgical Critical Care, (A.M.I., G.J., M.S., M.D., C.H.J., J.O.H., J.L., M.A.D., G.C.V., H.B.A.), Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; and Department of Surgery (G.J., B.L., H.B.A.), University of Michigan Hospital, Ann Arbor, Michigan.
J Trauma Acute Care Surg. 2013 Dec;75(6):976-83. doi: 10.1097/TA.0b013e31829e2186.
Combination of traumatic brain injury (TBI) and hemorrhagic shock (HS) can result in significant morbidity and mortality. We have previously shown that early administration of fresh frozen plasma (FFP) in a large animal model of TBI and HS reduces the size of the brain lesion as well as the associated edema. However, FFP is a perishable product that is not well suited for use in the austere prehospital settings. In this study, we tested whether a shelf-stable, low-volume, lyophilized plasma (LSP) product was as effective as FFP.
Yorkshire swine (42-50 kg) were instrumented to measure hemodynamic parameters, intracranial pressure, and brain tissue oxygenation. A prototype, computerized, cortical impact device was used to create TBI through a 20-mm craniotomy: 15-mm cylindrical tip impactor at 4 m/s velocity, 100-millisecond dwell time, and 12-mm penetration depth. Volume-controlled hemorrhage was induced (40-45% total blood volume) concurrent with the TBI. After 2 hours of shock, animals were treated with (1) normal saline (NS, n = 5), (2) FFP (n = 5), and (3) LSP (n = 5). The volume of FFP and LSP matched the shed blood volume, whereas NS was 3 times the volume. Six hours after resuscitation, brains were sectioned and stained with TTC (2, 3, 5-Triphenyltetrazolium chloride), and lesion size (mm) and swelling (percent change in volume compared with the contralateral, uninjured side) were measured.
This protocol resulted in a highly reproducible brain injury, with clinically relevant changes in blood pressure, cardiac output, tissue hypoperfusion, intracranial pressure, and brain tissue oxygenation. Compared with NS, treatment with LSP significantly (p < 0.05) decreased brain lesion size and swelling (51% and 54%, respectively).
In a clinically realistic combined TBI + HS model, early administration of plasma products decreases brain lesion size and edema. LSP is as effective as FFP, while offering many logistic advantages.
创伤性脑损伤（TBI）和出血性休克（HS）的联合作用可导致显著的发病率和死亡率。我们之前的研究表明，在 TBI 和 HS 的大型动物模型中早期给予新鲜冷冻血浆（FFP）可减少脑损伤的大小以及相关的水肿。然而，FFP 是一种易腐产品，不适用于恶劣的院前环境。在这项研究中，我们测试了一种稳定货架、低容量、冻干血浆（LSP）产品是否与 FFP 一样有效。
约克夏猪（42-50 公斤）被植入仪器以测量血流动力学参数、颅内压和脑组织氧合。使用原型、计算机控制的皮质撞击装置通过 20mm 的颅骨切开术创建 TBI：15mm 圆柱形尖端冲击器以 4m/s 的速度、100 毫秒的停留时间和 12mm 的穿透深度。在 TBI 同时诱导容量控制的出血（40-45%总血容量）。休克 2 小时后，动物接受以下治疗：（1）生理盐水（NS，n=5）、（2）FFP（n=5）和（3）LSP（n=5）。FFP 和 LSP 的体积与失血体积相匹配，而 NS 的体积是其 3 倍。复苏后 6 小时，将大脑切片并用 TTC（2,3,5-三苯基氯化四氮唑）染色，并测量损伤大小（mm）和肿胀（与对侧未受伤侧相比体积的变化百分比）。
该方案导致高度可重复的脑损伤，伴有临床相关的血压、心输出量、组织灌注不足、颅内压和脑组织氧合变化。与 NS 相比，LSP 的治疗显著（p<0.05）降低了脑损伤的大小和肿胀（分别为 51%和 54%）。
在临床现实的 TBI+HS 联合模型中，早期给予血浆产品可减少脑损伤的大小和水肿。LSP 与 FFP 一样有效，同时具有许多后勤优势。
