Carreiro Paulo Roberto Lima, Rezende-Neto Joao Baptista de, Lisboa Thiago de Assis, Ribeiro Daniel Dias, Camargos Elizabeth Ribeiro da Silva, Andrade Marcus Vinicius de Melo, Rizoli Sandro Baletotti, Melo Jose Renan da Cunha
Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
St. Michael's Hospital, University of Toronto, ON, Canada.
Acta Cir Bras. 2015 Mar;30(3):170-7. doi: 10.1590/S0102-865020150030000002.
To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding.
Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed.
Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM.
Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents.
研究补充凝血因子 XIII 和去氨加压素（DDAVP）在控制出血性复苏中的止血效果。
54 只兔子随机分为 9 组：G1：假手术组；G2：凝血因子 XIII 与正常血压复苏（NBP）组；G3：凝血因子 XIII 与允许性低血压（PH）组（平均动脉压为基线的 60%）；G4：凝血因子 XIII/DDAVP/NBP 组；G5：凝血因子 XIII/DDAVP/PH 组；G6：仅 NBP 组；G7：凝血因子 XIII 无出血组；G8：凝血因子 XIII/DDAVP 无出血组；G9：仅 PH 组。评估血栓弹力图和腹腔内失血量。对凝块进行扫描电子显微镜（EM）检查。
与假手术组相比，仅 G8（凝血因子 XIII/DDAVP 无出血组）的凝血时间（CT）显著降低（p<0.05）。与 G2、G3 和 G5 相比，单独的 NBP（G6）导致 CT 显著延长（p<0.05）。同样，与 G6 相比，G3、4、5 和 9 组的中位α角显著更大（p<0.05）。G5 的曲线下面积显著大于 G2。与 G2 和 G6 相比，G5 和 G9 的腹腔内失血量更低。凝血因子 XIII/DDAVP 和 PH 通过 EM 导致更坚固的纤维蛋白网。
与允许性低血压相比，正常血压复苏会引发更多出血并使凝血恶化，凝血因子 XIII 和去氨加压素可部分逆转这种情况。凝血因子 XIII 和 DDAVP 可协同改善凝血。无论使用这些药物与否，允许性低血压均可减少出血。
