The use of lyophilized plasma in a severe multi-injury pig model
The use of lyophilized plasma in a severe multi-injury pig model
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DOI：
10.1111/trf.12039
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发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Schreiber, Martin A.
中科院分区：
文献类型：
--
作者：
Lee, Tim H.;Van, Philbert Y.;Schreiber, Martin A.
背景休克和严重的组织损伤导致内源性凝血功能障碍，由蛋白C激活和高纤溶介导，称为急性创伤性凝血功能障碍。血液稀释、酸中毒、炎症和体温过低共同导致创伤性凝血病。创伤后凝血功能障碍与死亡率有关。早期有效的止血复苏对于恢复灌注、纠正凝血功能障碍和挽救失血创伤患者的生命至关重要。冻干血浆（LP）在物流上优于新鲜冷冻血浆（FFP）。研究设计和方法麻醉猪全血采集后进行血浆冻干处理。一系列的研究是用麻醉的猪进行的，猪接受了包括V级肝损伤在内的多创伤和失血性休克的验证模型。动物随机使用重组LP液体进行复苏。测量生理数据和出血量。评估凝血状态和炎症介质。结果与新鲜血浆相比，全体积重组LP （100%LP）平均保留了86%的凝血因子活性，当与红细胞以1:1的比例使用时，与FFP相比显示出更好的止血效果。使用原始血浆容量的50% （50%LP）重建的高渗LP具有更高的凝血因子浓度，在猪体内耐受性良好，并且在生理和止血特性方面与100%LP相同有效。抗坏血酸缓冲导致血清肿瘤坏死因子α和白细胞介素-6水平显著降低。结论通过减少重组LP的体积和优化其抗炎特性，可以制备出一种具有优良物流特性的有效止血复苏液。
Background Shock and severe tissue injury lead to an endogenous coagulopathy mediated by activation of Protein C and hyperfibrinolysis known as acute traumatic coagulopathy. Together, hemodilution, acidosis, inflammation, and hypothermia result in a global trauma-induced coagulopathy. Coagulopathy in trauma is associated with mortality. Early and effective hemostatic resuscitation is critical in restoring perfusion, correcting coagulopathy, and saving lives in exsanguinating trauma. Lyophilized plasma (LP) provides a logistically superior alternative to fresh frozen plasma (FFP).Study Design and Methods Plasma was lyophilized following whole blood collection from anesthetized swine. A series of studies were performed using anesthetized swine subjected to a validated model of polytrauma and hemorrhagic shock including a Grade V liver injury. Animals were randomized to resuscitation using reconstituted LP fluids. Physiologic data and blood loss were measured. Coagulation status and inflammatory mediators were evaluated.Results Full volume reconstituted LP (100%LP) retains on average 86% coagulation factor activity compared to fresh plasma and when used in 1:1 ratios with red blood cells demonstrated superior hemostatic efficacy compared to FFP. Hypertonic LP reconstituted using 50% of the original plasma volume (50%LP) had higher coagulation factor concentrations, was well tolerated in swine, and equally effective compared to 100%LP with respect to physiologic and hemostatic properties. Buffering with ascorbic acid resulted in significant reductions in serum levels of tumor necrosis factor alpha and interleukin-6.Conclusion By minimizing the volume of reconstituted LP and optimizing its anti-inflammatory properties, an LP resuscitation fluid may be created to provide effective hemostatic resuscitation with superior logistical properties.