Lyophilized Plasma for Resuscitation in a Swine Model of Severe Injury
Lyophilized Plasma for Resuscitation in a Swine Model of Severe Injury
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DOI：
10.1001/archsurg.2009.154
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发表时间：
2009-09-01
影响因子：
--
通讯作者：
Schreiber, Martin
中科院分区：
文献类型：
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作者：
Spoerke, Nicholas;Zink, Karen;Schreiber, Martin
假设：冻干血浆(LP)对严重创伤后的复苏与新鲜冰冻血浆(FFP)一样安全有效。设计：多中心动物研究。地点：动物实验室，2个I级创伤中心。参与者：32头约克郡杂交猪。干预：冻干血浆在冷冻干燥前和重建后分析因子水平和凝血活性。猪遭受复杂的多发伤，包括四肢骨折、出血、严重肝损伤、酸中毒和低温。然后用FFP、LP、FFP和红细胞(PRBC)按1：1或1：1的比例复苏。主要观察指标：重建后LP的残余凝血活性、猪死亡率、血流动力学指标、总出血量、凝血谱和炎症指标。结果：冷冻干燥使凝血因子活性平均降低1.4%。所有组的存活率和心率都是相似的。用LP复苏的猪的平均动脉压等于或更高。与FFP处理的猪相比，LP处理的猪的凝血谱、血浆乳酸水平和损伤后的失血量相似。FFP-PRBCs与1：1 LP-PRBCs相似。与FFP复苏相比，LP复苏后IL-6的表达明显降低。结论：冷冻干燥和血浆重建过程使凝血因子活性降低14%，失血量无明显差异。冻干血浆可用于严重多发伤失血性休克猪模型的复苏，其效果与FFP相当，同时白细胞介素6的产生减少。
Hypothesis: Lyophilized plasma (LP) is as safe and effective as fresh frozen plasma (FFP) for resuscitation after severe trauma.Design: Multicenter animal study.Setting: Animal laboratories, 2 level I trauma centers.Participants: Thirty-two Yorkshire crossbred swine.Interventions: Lyophilized plasma was analyzed for factor levels and clotting activity before lyophilization and after reconstitution. Swine were subjected to complex multiple trauma including extremity fracture, hemorrhage, severe liver injury, acidosis, and hypothermia. They were then resuscitated with FFP, LP, FFP and packed red blood cells (PRBCs) in a ratio of 1:1, or 1:1 LP and PRBCs.Main Outcome Measures: Residual clotting activity of LP after reconstitution, swine mortality, hemodynamic measures, total blood loss, coagulation profiles, and inflammatory measures.Results: Lyophilization decreased clotting factor activity by an average of 1.4%. Survival and heart rate were similar between all groups. Swine resuscitated with LP had equivalent or higher mean arterial pressures. Swine treated with LP had similar coagulation profiles, plasma lactate levels, and postinjury blood loss compared with those treated with FFP. Swine treated with 1:1. FFP-PRBCs were similar to those treated with 1:1 LP-PRBCs. Resuscitation with LP resulted in a reduction in postresuscitation interleukin 6 expression compared with resuscitation with FFP.Conclusions: The process of lyophilization and reconstitution of plasma reduces coagulation factor activity by 14%, without acute differences in blood loss. Lyophilized plasma can be used for resuscitation in a severe multiple trauma and hemorrhagic shock swine model with efficacy equal to that of FFP and with decreased interleukin 6 production.