Genét Gustav Folmer, Bentzer Peter, Ostrowski Sisse Rye, Johansson Pär Ingemar
1 Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen , Copenhagen, Denmark .
2 Department of Anesthesia and Intensive Care, Helsingborg Hospital , Helsingborg and Lund University, Lund, Sweden .
J Neurotrauma. 2017 Mar 1;34(5):1054-1062. doi: 10.1089/neu.2016.4574. Epub 2016 Oct 13.
Traumatic brain injury and hemorrhagic shock is associated with blood-brain barrier (BBB) breakdown and edema formation. Recent animal studies have shown that fresh frozen plasma (FFP) resuscitation reduces brain swelling and improves endothelial function compared to isotonic NaCl (NS). The aim of this study was to investigate whether pooled and pathogen-reduced plasma (OctaplasLG [OCTA]; Octapharma, Stockholm, Sweden) was comparable to FFP with regard to effects on brain water content, BBB permeability, and plasma biomarkers of endothelial glycocalyx shedding and cell damage. After fluid percussion brain injury, hemorrhage (20 mL/kg), and 90-min shock, 48 male Sprague-Dawley rats were randomized to resuscitation with OCTA, FFP, or NS (n = 16/group). Brain water content (wet/dry weight) and BBB permeability (transfer constant for Cr-EDTA) were measured at 24 h. Plasma osmolality, oncotic pressure, and biomarkers of systemic glycocalyx shedding (syndecan-1) and cell damage (histone-complexed DNA) were measured at 0 and 23 h. At 24 h, brain water content was 80.44 ± 0.39%, 80.82 ± 0.82%, and 81.15 ± 0.86% in the OCTA, FFP, and NS groups (lower in OCTA vs. NS; p = 0.026), with no difference in BBB permeability. Plasma osmolality and oncotic pressures were highest in FFP and OCTA resuscitated, and osmolality was further highest in OCTA versus FFP (p = 0.027). In addition, syndecan-1 was highest in FFP and OCTA resuscitated (p = 0.010). These results suggest that pooled solvent-detergent (SD)-treated plasma attenuates the post-traumatic increase in brain water content, and that this effect may, in part, be explained by a high crystalloid and colloid osmotic pressure in SD-treated plasma.
创伤性脑损伤和失血性休克与血脑屏障（BBB）破坏及水肿形成有关。最近的动物研究表明，与等渗氯化钠溶液（NS）相比，新鲜冷冻血浆（FFP）复苏可减轻脑肿胀并改善内皮功能。本研究的目的是调查汇集并经过病原体灭活的血浆（OctaplasLG [OCTA]；瑞典斯德哥尔摩奥克塔法玛公司）在对脑含水量、血脑屏障通透性以及内皮糖萼脱落和细胞损伤的血浆生物标志物的影响方面是否与FFP相当。在进行液压颅脑损伤、出血（20 mL/kg）和90分钟休克后，将48只雄性Sprague-Dawley大鼠随机分为用OCTA、FFP或NS进行复苏的组（每组n = 16）。在24小时时测量脑含水量（湿重/干重）和血脑屏障通透性（Cr-EDTA的转运常数）。在0小时和23小时时测量血浆渗透压、胶体渗透压以及全身糖萼脱落（syndecan-1）和细胞损伤（组蛋白复合DNA）的生物标志物。在24小时时，OCTA组、FFP组和NS组的脑含水量分别为80.44 ± 0.39%、80.82 ± 0.82%和81.15 ± 0.86%（OCTA组低于NS组；p = 0.026），血脑屏障通透性无差异。FFP和OCTA复苏组的血浆渗透压和胶体渗透压最高，且OCTA组的渗透压进一步高于FFP组（p = 0.027）。此外，FFP和OCTA复苏组的syndecan-1最高（p = 0.010）。这些结果表明，汇集的溶剂去污剂（SD）处理血浆可减轻创伤后脑含水量的增加，且这种作用可能部分由SD处理血浆中的高晶体和胶体渗透压所解释。
