Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
Institute of Legal Medicine, Hannover Medical School, Hannover, Germany.
Korean J Anesthesiol. 2020 Aug;73(4):334-341. doi: 10.4097/kja.20071. Epub 2020 Apr 16.
Twenty-five to 85% of trauma patients are under the influence of alcohol in addition to experiencing injury-related coagulation impairment. Viscoelastic point-of-care tests (thrombelastography [TEG], rotational thromboelastometry [ROTEM]) are popular tools for rapid hemostasis assessment and therapeutic decision-making in this and other settings. While alcohol affects these tests in-vitro, their specific effects in-vivo are unclear. Therefore, we evaluated the effects of alcohol ingestion on ROTEM parameters.
Twenty volunteers provided informed consent to drinking red wine, whisk(e)y, or vodka to a target blood alcohol concentration of 1 ‰ within one hour, calculated with the Widmark formula. Blood samples were collected before drinking, at a breath alcohol concentration of 0.5 ‰, and at 1.0 ‰, but no later than one hour. After each blood collection, ExTEM and FibTEM tests were performed directly "at the bedside."
All participants had a blood alcohol concentration (BAC) of 0.00 ‰ at the beginning. The mean BACs at the second and third collection were 0.48 and 0.76 ‰, respectively. There were no significant differences in the ExTEM parameters. FibTEM measurements showed a significant difference at the A10 value (13.0 vs. 14.0 mm, P = 0.014) and a trend at the maximum amplitude (maximum clot firmness [MCF] 13.7 vs. 16.2 mm, P = 0.075). We saw no significant differences in fibrinolysis parameters and no hyperfibrinolysis in our ROTEM measurements.
Ethanol ingestion can impair early fibrin polymerization. These results might be of special relevance in trauma and support routine application of ROTEM/TEG in such cases.
25%至 85%的创伤患者除了经历与损伤相关的凝血功能障碍外，还受到酒精的影响。粘弹性即时检测（血栓弹力图[TEG]、旋转血栓弹性测定法[ROTEM]）是快速评估止血和在这种情况下及其他情况下做出治疗决策的常用工具。尽管酒精会影响这些检测在体外的结果，但它们在体内的具体影响尚不清楚。因此，我们评估了酒精摄入对 ROTEM 参数的影响。
20 名志愿者同意在一小时内饮用红酒、威士忌或伏特加，使血液酒精浓度达到 1‰，根据 Widmark 公式计算。在饮酒前、呼气酒精浓度为 0.5‰和 1.0‰时采集血液样本，但不晚于一小时。每次采血后，直接在“床边”进行 EXTEM 和 FibTEM 检测。
所有参与者在开始时的血液酒精浓度（BAC）均为 0.00‰。第二次和第三次采集的平均 BAC 分别为 0.48‰和 0.76‰。EXTEM 参数无显著差异。FibTEM 测量结果显示 A10 值有显著差异（13.0 与 14.0mm，P=0.014），最大振幅有趋势差异（最大凝块硬度[MCF]13.7 与 16.2mm，P=0.075）。我们在纤维蛋白溶解参数方面未观察到显著差异，也未在 ROTEM 测量中观察到高纤维蛋白溶解。
乙醇摄入可损害早期纤维蛋白聚合。这些结果在创伤中可能具有特殊意义，并支持在这种情况下常规应用 ROTEM/TEG。
