Lawrence Matthew James, Marsden Nick, Kaczynski Jakub, Davies Gareth, Davies Nia, Hawkins Karl, Perumal Sounder, Brown Martin Rowan, Morris Keith, Davidson Simon J, Williams Phylip Rhodri, Evans Phillip Adrian
From the *NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, United Kingdom; †NISCHR Biomedical Research Unit, Medical School, Swansea University, Swansea, United Kingdom; ‡The Welsh Centre for Burns and Plastic Surgery, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, United Kingdom; §Department of Surgery, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea University, Swansea, United Kingdom; ∥Emergency Department, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, United Kingdom; ¶Centre of Complex Fluids, College of Engineering, Swansea University, Swansea, United Kingdom; #School of Applied Science, University of Wales Institute Cardiff, Cardiff, United Kingdom; and **Department of Haematology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Anesth Analg. 2016 Nov;123(5):1081-1088. doi: 10.1213/ANE.0000000000001536.
Balancing the beneficial effects of resuscitation fluids against their detrimental effect on hemostasis is an important clinical issue. We aim to compare the in vitro effects of 3 different colloid resuscitation fluids (4.5% albumin, hydroxyethyl starch [Voluven 6%], and gelatin [Geloplasma]) on clot microstructure formation using a novel viscoelastic technique, the gel point. This novel hemorheologic technique measures the biophysical properties of the clot and provides an assessment of clot microstructure from its viscoelastic properties. Importantly, in contrast to many assays in routine clinical use, the measurement is performed using unadulterated whole blood in a near-patient setting and provides rapid assessment of coagulation. We hypothesized that different colloids will have a lesser or greater detrimental effect on clot microstructure formation when compared against each other.
Healthy volunteers were recruited into the study (n = 104), and a 20-mL sample of whole blood was obtained. Each volunteer was assigned to 1 of the 3 fluids, and the sample was diluted to 1 of 5 different dilutions (baseline, 10%, 20%, 40%, and 60%). The blood was tested using the gel point technique, which measures clot mechanical strength and quantifies clot microstructure (df) at the incipient stages of fibrin formation.
df and clot mechanical strength decrease with progressive dilution for all 3 fluids. A significant reduction in df from baseline was recorded at dilutions of 20% for albumin (P < .0001), 40% for starch (P < .0001), and 60% for gelatin (P < .0001). We also observed significant differences, in terms of df, when comparing the different types of colloid (P < .0001). We found that albumin dilution produced the largest changes in clot microstructure, providing the lowest values of df (= 1.41 ± 0.061 at 60% dilution) compared with starch (1.52 ± 0.081) and gelatin (1.58 ± 0.063).
We show that dilution with all 3 fluids has a significant effect on coagulation at even relatively low dilution volumes (20% and 40%). Furthermore, we quantify, using a novel viscoelastic technique, how the physiochemical properties of the 3 colloids exert individual changes on clot microstructure.
平衡复苏液体的有益作用及其对止血的不利影响是一个重要的临床问题。我们旨在使用一种新型粘弹性技术——凝胶点，比较3种不同胶体复苏液体（4.5%白蛋白、羟乙基淀粉[万汶6%]和明胶[血浆代用品]）对血凝块微观结构形成的体外影响。这种新型血液流变学技术可测量血凝块的生物物理特性，并根据其粘弹性特性评估血凝块的微观结构。重要的是，与许多常规临床检测方法不同，该测量是在接近患者的环境中使用未掺杂的全血进行的，可快速评估凝血功能。我们假设，相互比较时，不同胶体对血凝块微观结构形成的不利影响会有大有小。
招募健康志愿者参与研究（n = 104），采集20 mL全血样本。每位志愿者被分配到3种液体中的1种，样本被稀释至5种不同稀释度（基线、10%、20%、40%和60%）中的1种。使用凝胶点技术检测血液，该技术可测量血凝块的机械强度，并在纤维蛋白形成的初始阶段量化血凝块微观结构（df）。
对于所有3种液体，df和血凝块机械强度均随稀释程度的增加而降低。白蛋白在20%稀释度时df较基线显著降低（P <.0001），淀粉在40%稀释度时（P <.0001），明胶在60%稀释度时（P <.0001）。比较不同类型胶体时，我们还观察到df存在显著差异（P <.0001）。我们发现，白蛋白稀释对血凝块微观结构的影响最大，与淀粉（1.52 ± 0.081）和明胶（1.58 ± 0.063）相比，在60%稀释度时df值最低（1.41 ± 0.061）。
我们表明，即使在相对较低的稀释体积（20%和40%）下，用所有3种液体进行稀释对凝血也有显著影响。此外，我们使用一种新型粘弹性技术量化了3种胶体的物理化学特性如何对血凝块微观结构产生各自不同的影响。
