靶向纤维蛋白原浓缩物在严重创伤性出血中的应用。

Targeted fibrinogen concentrate use in severe traumatic haemorrhage.

机构信息

Gold Coast Health, Gold Coast, QLD, Australia.

Griffith University, Gold Coast, QLD, Australia.

出版信息

Crit Care Resusc. 2019 Sep;21(3):171-178.

PMID:31462204

Abstract

OBJECTIVE

Fibrinogen is one of the first coagulation factors to be depleted during traumatic haemorrhage, and evidence suggests hypofibrinogenaemia leads to poor outcomes. A number of fibrinogen replacement products are currently available, with no clear consensus on the ideal product to use in severe traumatic haemorrhage. We hypothesised that it will be possible to rapidly administer fibrinogen concentrate (FC) guided by rotational thromboelastometry (ROTEM) FIBTEM A5 in patients presenting with trauma haemorrhage.

METHODS

We examined 36 consecutive patients with trauma admitted to a level 1 trauma centre in Australia who received FC as part of their initial resuscitation. ROTEM analysis was conducted at various time points from emergency department (ED) admission to 48 hours after admission. The primary outcome was time to administration of FC after identification of hypofibrinogenaemia using ROTEM FIBTEM A5. Data were collected on quantity and timing of product transfusion, demographics, Injury Severity Score and laboratory values of coagulation. Spearman rank order correlation was used to determine the correlation between FIBTEM A5 and Clauss fibrinogen (FibC).

RESULTS

Thirty-six patients received FC as their initial form of fibrinogen replacement during the study. Patients were hypofibrinogenaemic by both FIBTEM A5 (6 mm) and FibC (1.7 g/L) on presentation to the ED. It took a median of 22 minutes (IQR, 17-30 minutes) from time of a FIBTEM A5 analysis to FC administration. Both parameters increased significantly ( < 0.05) by 24 hours after admission.

CONCLUSION

This study suggests that administration of FC represents a rapid and feasible method to replace fibrinogen in severe traumatic haemorrhage. However, the optimal method for replacing fibrinogen in traumatic haemorrhage is controversial and large multicentre randomised controlled trials are needed to provide further evidence. This study provided baseline data to inform the design of further clinical trials investigating fibrinogen replacement in traumatic haemorrhage.

摘要

目的

纤维蛋白原是创伤性出血过程中最早消耗的凝血因子之一，有证据表明，低纤维蛋白原血症会导致不良预后。目前有多种纤维蛋白原替代产品，但在严重创伤性出血中使用哪种产品尚无明确共识。我们假设，根据旋转血栓弹性测定法（ROTEM）的纤维蛋白原检测（FIBTEM）A5，可以快速给予纤维蛋白原浓缩物（FC）。

方法

我们检查了澳大利亚 1 级创伤中心收治的 36 例创伤患者，他们在初始复苏过程中接受了 FC。在急诊科（ED）入院时到入院后 48 小时进行 ROTEM 分析。主要结局是在使用 ROTEM FIBTEM A5 确定低纤维蛋白原血症后，给予 FC 的时间。收集了产品输注的数量和时间、人口统计学、损伤严重程度评分和凝血实验室值的数据。采用 Spearman 秩相关分析来确定 FIBTEM A5 与 Clauss 纤维蛋白原（FibC）之间的相关性。

结果

在研究期间，36 例患者接受了 FC 作为他们最初的纤维蛋白原替代物。患者在 ED 就诊时，纤维蛋白原检测（FIBTEM A5，6mm）和 FibC（1.7g/L）均低于正常值。从 FIBTEM A5 分析到 FC 给药的中位数时间为 22 分钟（IQR，17-30 分钟）。入院后 24 小时，这两个参数均显著增加（<0.05）。