From the Department of Surgery (A.D., M.B., S.Sm., B.B., L.A., E.B., J.M., B.M., B.MC., A.G., A.K., T.S., S.Sa., M.S.) Oregon Health & Science University, Portland, Oregon; Department of Laboratory Medicine (A.T., S.P.), University of California San Francisco, San Francisco, California.
J Trauma Acute Care Surg. 2022 Jul 1;93(1):124-129. doi: 10.1097/TA.0000000000003584. Epub 2022 Mar 7.
Moderate injury can lead to a coagulopathy. Fresh frozen plasma (FFP) corrects coagulopathy by means of a balanced array of clotting factors. We sought to compare the late effects of FFP and a prothrombin complex concentrate (PCC) on the coagulopathy of trauma using a porcine model of pulmonary contusion (PC) and hemorrhagic shock (HS) designed to evaluate the organ protective effects of these treatments.
Female Yorkshire swine (40-50 kg) were randomized to receive PC + HS or control (instrumented and uninjured). A blunt PC was created using a captive bolt gun. To induce HS, a liver crush injury was performed. Eighty minutes after injury, swine were treated with 25 U·kg-1 PCC, 1 U FFP, or 50 mL lactated Ringer's vehicle in a blinded manner. Arterial blood samples were drawn every 6 hours. Swine were euthanized 48 hours postinjury. Data were analyzed by Pearson χ2, analysis of variance and Kruskal-Wallis tests with Tukey's or Mann-Whitney U tests for post hoc analysis.
Twenty-seven swine received PC + HS, 3 groups of 9 per group received PCC, FFP, or vehicle. Nine were noninjured controls. When compared with control, PC + HS swine had significantly shortened R time at 6 hours, 36 hours, and 42 hours, decreased LY30 at 12 hours, shortened K time at 30 hours and reduced α angle at 42 hours. PC + HS swine showed significant differences between treatment groups in K and α angle at 3 hours, LY30 at 12 hours and 18 hours, and MA at 12 hours, 18 hours, and 30 hours. Post hoc analysis was significant for higher α angle in PCC versus vehicle at 3 hours, higher MA in vehicle versus PCC at 12 hours and 18 hours, and higher LY30 in PCC versus vehicle at 18 hours (p < 0.012) with no significant differences between FFP and vehicle.
Severe injury with HS induced a coagulopathy in swine. While FFP maintained normal coagulation following injury, PCC induced more rapid initial clot propagation in injured animals.
中度损伤可导致凝血功能障碍。新鲜冷冻血浆（FFP）通过平衡的凝血因子纠正凝血功能障碍。我们旨在通过设计一种猪肺挫伤（PC）和失血性休克（HS）的模型，来比较 FFP 和凝血酶原复合物浓缩物（PCC）对创伤后凝血功能障碍的迟发效应，该模型旨在评估这些治疗方法的器官保护作用。
雌性约克夏猪（40-50 千克）随机分为接受 PC + HS 或对照（仪器和未受伤）。使用捕获螺栓枪创建钝性 PC。为了诱导 HS，进行肝挤压伤。损伤后 80 分钟，以盲法方式用 25U·kg-1 的 PCC、1U 的 FFP 或 50mL 乳酸林格氏载体治疗猪。每 6 小时采集动脉血样。伤后 48 小时处死猪。通过 Pearson χ2、方差分析和 Kruskal-Wallis 检验，以及事后分析的 Tukey 或 Mann-Whitney U 检验对数据进行分析。
27 头猪接受了 PC + HS，每组 9 头，分为 PCC、FFP 或载体组。9 头为未受伤对照。与对照组相比，PC + HS 猪在 6 小时、36 小时和 42 小时时的 R 时间明显缩短，12 小时时的 LY30 减少，30 小时时的 K 时间缩短，42 小时时的 α 角减小。PC + HS 猪在 3 小时时的 K 和 α 角、12 小时和 18 小时时的 LY30、12 小时、18 小时和 30 小时时的 MA 方面，各组之间存在显著差异。事后分析显示，在 3 小时时 PCC 与载体相比，α 角较高，在 12 小时和 18 小时时 MA 较高，在 18 小时时 LY30 较高（p<0.012），FFP 与载体之间无显著差异。
HS 引起的严重损伤导致猪发生凝血功能障碍。FFP 可维持损伤后正常凝血，而 PCC 可在受伤动物中更快地引发初始凝血。
