纤维蛋白原浓缩物和血小板复苏在创伤性出血猪模型中的疗效。

Efficacy of resuscitation with fibrinogen concentrate and platelets in traumatic hemorrhage swine model.

机构信息

From the US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas.

出版信息

J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S137-S145. doi: 10.1097/TA.0000000000002736.

DOI:10.1097/TA.0000000000002736

PMID:32301889

Abstract

BACKGROUND

This study compared the resuscitation effects of platelets and fibrinogen concentrate (FC) on coagulation and hemodynamics in pigs with traumatic hemorrhage and reduced platelet counts.

METHODS

Thirty pigs (40 ± 3 kg) were anesthetized and catheterized with an apheresis catheter to remove platelets using the Haemonetics 9000 (Haemonetics, Braintree, MA). Afterward, a femur fracture was induced, followed by hemorrhage of 35% the estimated blood volume. Pigs were then randomized to be resuscitated with 5% human albumin (12.5 mL/kg), FC (250 mg/kg, 12.5 mL/kg), or platelets collected from apheresis (11.0 ± 0.5 mL/kg). Animals were monitored for 2 hours or until death. Blood samples were collected before (baseline [BL]) and after apheresis, after hemorrhage, and after resuscitation to assess changes in hemodynamics and coagulation using Rotem.

RESULTS

No change in mean arterial pressure (MAP) or heart rate (HR) was observed by platelet apheresis. Hemorrhage reduced MAP to 57% ± 5% and elevated HR to 212% ± 20% of BL (both p < 0.05). Resuscitation with albumin, FC, or platelets did not revert MAP or HR to BL. Platelet counts were reduced by apheresis from BL 383 ± 20 × 10/μL to 141 ± 14 × 10/μL and were reduced further after resuscitation with albumin (88 ± 18 × 10/μL) or FC (97 ± 13 × 10/μL, all p < 0.05), but improved with platelet resuscitation (307 ± 24 × 10/μL). Fibrinogen concentration was reduced by apheresis from BL 225 ± 9 mg/dL to 194 ± 8 mg/dL, fell after albumin infusion (134 ± 11 mg/dL), increased to 269 ± 10 mg/dL after FC resuscitation (all p < 0.05), and was not affected by platelet resuscitation. Rotem α-angle decreased from 79 ± 2 degrees to 69 ± 1 degrees by apheresis and hemorrhage (p < 0.05), and recovered similarly by resuscitation with FC (87 ± 1 degrees) or platelets (78 ± 2 degrees), but not by albumin (63 ± 3 degrees). Similar responses were observed in Rotem maximum clot firmness.

CONCLUSION

In this traumatic hemorrhage swine model, low-volume resuscitation with FC or platelets was similarly effective in restoring coagulation.

摘要

背景

本研究比较了血小板和纤维蛋白原浓缩物（FC）在创伤性出血和血小板计数减少的猪模型中对凝血和血流动力学的复苏效果。

方法

30 头（40±3kg）猪被麻醉，并通过单采术导管（Haemonetics 9000，Braintree，MA）去除血小板。之后，诱导股骨骨折，然后出血 35%估计的血容量。然后将猪随机分为用 5%人白蛋白（12.5mL/kg）、FC（250mg/kg，12.5mL/kg）或从单采术收集的血小板（11.0±0.5mL/kg）复苏。动物监测 2 小时或直至死亡。在单采术前后（基线[BL]）、出血后和复苏后采集血液样本，使用 Rotem 评估血流动力学和凝血的变化。

结果

血小板单采术对平均动脉压（MAP）或心率（HR）没有影响。出血将 MAP 降低至 BL 的 57%±5%，并将 HR 升高至 BL 的 212%±20%（均 p<0.05）。白蛋白、FC 或血小板复苏均未使 MAP 或 HR 恢复到 BL。血小板计数从 BL 的 383±20×10/μL 降低至 141±14×10/μL，用白蛋白（88±18×10/μL）或 FC（97±13×10/μL）复苏后进一步降低（均 p<0.05），但血小板复苏后改善（307±24×10/μL）。纤维蛋白原浓度从 BL 的 225±9mg/dL 降低至 194±8mg/dL，白蛋白输注后降低（134±11mg/dL），FC 复苏后增加至 269±10mg/dL（均 p<0.05），血小板复苏对其无影响。Rotem α 角从 79±2 度降低至 69±1 度，通过单采术和出血（p<0.05），FC 或血小板复苏后恢复相似（87±1 度），但白蛋白复苏后无变化（63±3 度）。最大凝块硬度的 Rotem 反应类似。