Nishi Kouichirou, Takasu Akira, Shinozaki Hirotoshi, Sakamoto Ken, Yamamoto Yorihiro, Sakamoto Toshihisa
Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa Japan.
Department of Emergency Medicine Osaka Medical College Takatsuki Japan.
Acute Med Surg. 2014 Aug 21;2(1):29-34. doi: 10.1002/ams2.60. eCollection 2015 Jan.
The aim of this study was to investigate the effect of hypothermia on survival and coagulopathy in hemorrhagic shock presenting as the "triad of death".
Sixteen rats were lightly anesthetized with halothane while maintaining spontaneous breathing. The triad of death was simulated by inducing hypothermia (32.0°C) with surface body cooling and hemodilution with replacement of 20 mL blood with 50 mL normal saline. Then, rats were randomly assigned to one of two rectal temperature groups ( = 8/group: group 1, rewarming to 37.0°C; group 2, maintenance at 32.0°C) and subjected to hemorrhagic shock initiated by amputation of the tail at 75% of its length. The rats were then observed for survival time without fluid resuscitation. Blood coagulability with Sonoclot analysis was also assessed.
The triad of death status was considered as being induced at a rectal temperature of 32°C, arterial pH of 7.22, and deteriorating coagulating values. At 45 min after randomization, Sonoclot analysis revealed prolonged activated clotting times of 355 ± 131 s and "time to peak" of 23 ± 9 min in group 2, compared to 228 ± 64 s and 12 ± 1 min ( < 0.05) in group 1, respectively. Kaplan-Meier curves showed longer survival in group 2 than group 1 ( = 0.06).
Compared to rewarming, hypothermia aggravates coagulation parameters, but does not hasten death during untreated hemorrhagic shock presenting as the triad of death.
本研究旨在探讨低温对表现为“死亡三联征”的失血性休克患者生存及凝血功能障碍的影响。
16只大鼠用氟烷轻度麻醉，同时维持自主呼吸。通过体表降温诱导低温（32.0°C）并用50 mL生理盐水替代20 mL血液进行血液稀释来模拟死亡三联征。然后，将大鼠随机分为两个直肠温度组之一（每组 = 8只：第1组，复温至37.0°C；第2组，维持在32.0°C），并通过截断75%长度的尾巴引发失血性休克。随后观察大鼠在无液体复苏情况下的生存时间。还通过Sonoclot分析评估血液凝固性。
死亡三联征状态被认为是在直肠温度为32°C、动脉pH值为7.22且凝血值恶化时诱导产生的。随机分组后45分钟，Sonoclot分析显示，第2组活化凝血时间延长至355 ± 131秒，“达到峰值时间”为23 ± 9分钟，而第1组分别为228 ± 64秒和12 ± 1分钟（P < 0.05）。Kaplan-Meier曲线显示第2组的生存时间长于第1组（P = 0.06）。
与复温相比，低温会加重凝血参数，但在表现为死亡三联征的未经治疗的失血性休克期间不会加速死亡。
