Selby J B, Mathis J E, Berry C F, Hagedorn F N, Illner H P, Shires G T
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock 79430, USA.
Surgery. 1996 May;119(5):528-33. doi: 10.1016/s0039-6060(96)80262-5.
It has been suggested that fluid resuscitation before surgical control of hemorrhage may lead to increased bleeding because of the elevated blood pressures and clotting factor dilution. This study was designed to assess the effects of isotonic saline solution resuscitation on blood coagulation during uncontrolled hemorrhage.
Twenty-four female Sprague-Dawley rats were randomized into four groups with different resuscitation regimens: group A, no resuscitation; group B, 40 ml/kg in 4 minutes; group C, 80 ml/kg in 4 minutes; and group D, 80 ml/kg in 1 minute. Baseline blood samples were collected just before a sharp resection of 75% of the tail to initiate the hemorrhage; 15 minutes later the resuscitation began. Additional blood samples were obtained at 60 minutes after resection. The blood was analyzed for platelets, fibrinogen, prothrombin time, and activated partial thromboplastin time.
The largest differences between time 0 and 60 minutes were observed in group D with platelets decreasing 43.36% +/- 7.86%, fibrinogen decreasing 57.10% +/- 16.88%, and prothrombin time increasing from an average 16.5 to 19.2 seconds. These differences was statistiacally significant (p <0.05) with the Student's test.
The results suggested that even though the volume of resuscitation fluid did not appear to affect clotting time when compared with that of nonresuscitated animals, the rate of extremely large volume infusions may play an important role in the cessation of bleeding and consequently in the management of uncontrolled hemorrhagic shock.
有人提出，在手术控制出血之前进行液体复苏可能会因血压升高和凝血因子稀释而导致出血增加。本研究旨在评估等渗盐溶液复苏对未控制出血期间血液凝固的影响。
将24只雌性Sprague-Dawley大鼠随机分为四组，采用不同的复苏方案：A组，不复苏；B组，4分钟内输注40 ml/kg；C组，4分钟内输注80 ml/kg；D组，1分钟内输注80 ml/kg。在锐性切除75%的尾巴以引发出血之前采集基线血样；15分钟后开始复苏。切除后60分钟采集额外的血样。对血液进行血小板、纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间分析。
D组在0分钟和60分钟之间观察到最大差异，血小板减少43.36%±7.86%，纤维蛋白原减少57.10%±16.88%，凝血酶原时间从平均16.5秒增加到19.2秒。采用学生检验，这些差异具有统计学意义（p<0.05）。
结果表明，尽管与未复苏的动物相比，复苏液的量似乎不影响凝血时间，但极大量输注的速度可能在止血以及因此在未控制出血性休克的管理中起重要作用。
