Cohn S M, Cross J H, Ivy M E, Feinstein A J, Samotowka M A
Department of Surgery, University of Miami Medical School, Florida 33101, USA.
J Trauma. 1998 Oct;45(4):666-72. doi: 10.1097/00005373-199810000-00004.
We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury.
Femoral arterial and venous catheters were placed in pentobarbital-anesthetized swine (n=7 per group, 16-18 kg). Pigs received an external blast to the right upper abdomen at 0 minutes, followed by uncontrolled hemorrhage at 0 to 30 minutes, with anticoagulation (heparin, 200 U/kg) at 10 minutes. Pigs were resuscitated with lactated Ringer's solution (20 mL/kg) beginning at 15 minutes and then underwent laparotomy to control bleeding at 30 minutes. Lactated Ringer's solution was infused to keep mean arterial pressure greater than 70 mm Hg until 120 minutes, when repeat laparotomy was performed. Control animals (group 1) underwent routine surgical procedures to terminate bleeding followed by packing if hepatic bleeding continued. The FG animals (group II) underwent routine surgical procedures plus application of FG. Avoidance of packing, estimated blood loss (EBL) during and after laparotomy, and fluid resuscitation volume were the primary end points studied.
In both groups, mean arterial pressure varied significantly from baseline to 120 minutes (group I: 100+/-3 to 52+/-11 mm Hg; group II: 99+/-4 to 66+/-3 mm Hg). Temperature decreased at the end of each experiment (group I: 37+/-1 to 33+/-1 degrees C; group II: 37+/-1 to 34+/-1 degrees C). There were no group differences in EBL before laparotomy (0-30 minutes), but from initial laparotomy to repeat laparotomy (30-120 min), EBL (group I: 875+/-265 mL; group II: 300+/-59 mL) and total fluid resuscitation (group I: 2.9+/-0.4 L; group II: 1.9+/-0.3 L) were statistically significantly less in FG pigs. Of greatest importance, six of seven control pigs required packing, but none of the FG animals were packed and none bled at repeat laparotomy.
FG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.
我们在一种新的复杂肝损伤猪模型中，确定了一种包装好的纤维蛋白胶（FG）产品终止严重出血的能力。
将股动脉和静脉导管置入戊巴比妥麻醉的猪体内（每组7只，体重16 - 18千克）。猪在0分钟时右上腹受到外部冲击，随后在0至30分钟内出现无法控制的出血，并在10分钟时给予抗凝（肝素，200 U/kg）。猪在15分钟开始用乳酸林格氏液（20 mL/kg）进行复苏，然后在30分钟时进行剖腹手术以控制出血。持续输注乳酸林格氏液以维持平均动脉压大于70 mmHg直至120分钟，此时进行再次剖腹手术。对照组动物（第1组）采用常规外科手术终止出血，若肝出血持续则进行填塞。FG组动物（第2组）采用常规外科手术加应用FG。避免填塞、剖腹手术期间及术后的估计失血量（EBL）以及液体复苏量是研究的主要终点。
两组中，平均动脉压从基线到120分钟均有显著变化（第1组：100±3至52±11 mmHg；第2组：99±4至66±3 mmHg）。每次实验结束时体温均下降（第1组：37±1至33±1℃；第2组：37±1至34±1℃）。剖腹手术前（0 - 30分钟）EBL在两组间无差异，但从初次剖腹手术到再次剖腹手术（30 - 120分钟），FG组猪的EBL（第1组：875±265 mL；第2组：300±59 mL）和总液体复苏量（第1组：2.9±0.4 L；第2组：1.9±0.3 L）在统计学上显著更少。最重要的是，7只对照组猪中有6只需要填塞，但FG组动物均未进行填塞，且在再次剖腹手术时均未出血。
在严重肝损伤模型中，FG可止血并消除填塞的必要性。有必要在临床领域进一步开展工作，以确定FG在救治伴有复杂内脏损伤的低血压、低体温、凝血功能障碍创伤患者时在止血方面的潜在益处。
