创伤性凝血病中的纤维蛋白原和凝血酶原复合物浓缩物

Fibrinogen and prothrombin complex concentrate in trauma coagulopathy.

作者信息

Hannon Matthew, Quail Jacob, Johnson Matthew, Pugliese Cara, Chen Kejian, Shorter Heidi, Riffenburgh Robert, Jackson Ronald

机构信息

Department of General Surgery, Naval Medical Center San Diego, San Diego, California.

出版信息

J Surg Res. 2015 Jun 15;196(2):368-72. doi: 10.1016/j.jss.2015.03.013. Epub 2015 Mar 16.

DOI:10.1016/j.jss.2015.03.013

PMID:25881790

Abstract

BACKGROUND

Coagulopathy after injury contributes to hemorrhage and death. Treatment with specific coagulation factors could decrease hemorrhage and mortality. Our aim was to compare fibrinogen and prothrombin complex concentrate (PCC) in a rabbit model of hemorrhagic shock.

MATERIALS AND METHODS

New Zealand white rabbits were anesthetized. Blood was withdrawn to a mean arterial pressure (MAP) of 30-40 mm Hg for 30 min. Animals were resuscitated with lactated Ringer to a MAP of 50-60 mm Hg and randomized to receive 100 mg/kg of fibrinogen, PCC 25 IU/kg, or lactated Ringer. A liver injury was created. A MAP of 50-60 mm Hg was maintained for 60 min. The primary outcome was blood loss, and secondary outcomes were fluid administered and coagulopathy as measured by plasma-based tests.

RESULTS

There were eight animals in each group. Median blood loss was significantly higher in the fibrinogen group, at 122 mL (95% confidence interval [CI], 75-194), when compared with that in the control group, 35 mL (95% CI, 23-46; P value = 0.001), and the PCC group, 26 mL (95% CI, 4-54; P value = 0.002). Resuscitation fluid requirement was highest in the fibrinogen group, at 374 mL (95% CI, 274-519), and lowest in the PCC group, at 238 mL (95% CI, 212-309) (P = 0.01). Plasma-based coagulation tests were not different among groups.

CONCLUSIONS

In a rabbit model, PCC did not have a significant effect on blood loss. Fibrinogen increased blood loss and fluid requirements.

摘要

背景

创伤后的凝血功能障碍会导致出血和死亡。使用特定凝血因子进行治疗可减少出血和降低死亡率。我们的目的是在兔出血性休克模型中比较纤维蛋白原和凝血酶原复合物浓缩剂（PCC）。

材料与方法

将新西兰白兔麻醉。抽血使平均动脉压（MAP）降至30 - 40 mmHg并维持30分钟。动物用乳酸林格液复苏至MAP为50 - 60 mmHg，然后随机分为三组，分别接受100 mg/kg纤维蛋白原、25 IU/kg PCC或乳酸林格液。造成肝损伤。将MAP维持在50 - 60 mmHg 60分钟。主要结局指标是失血量，次要结局指标是补液量以及通过基于血浆的检测方法测定的凝血功能障碍。

结果

每组有8只动物。与对照组的35 mL（95%置信区间[CI]，23 - 46；P值 = 0.001）和PCC组的26 mL（95% CI，4 - 54；P值 = 0.002）相比，纤维蛋白原组的中位失血量显著更高，为122 mL（95% CI，75 - 194）。纤维蛋白原组的复苏液体需求量最高，为374 mL（95% CI，274 - 519），PCC组最低，为238 mL（95% CI，212 - 309）（P = 0.01）。基于血浆的凝血检测在各组之间无差异。