Recombinant activated factor VII increases survival time in a model of incompressible arterial hemorrhage in the anesthetized pig.
Recombinant activated factor VII increases survival time in a model of incompressible arterial hemorrhage in the anesthetized pig.
复制标题
重组活化因子 VII 可延长麻醉猪不可压缩动脉出血模型的存活时间。
DOI：
10.1097/ta.0b013e318034204b
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
E. Kirkman
中科院分区：
文献类型：
--
作者：
W. Sapsford;S. Watts;G. Cooper;E. Kirkman
背景
出血是战场伤亡的主要死因，也是仅次于平民创伤的第二大死因。军事伤员后送至外科治疗的时间可以延长，改善止血可以大大降低死亡率。有几个轶事报道，重组活化因子VII（rFVIIa）可以阻止创伤后不受控制的出血。然而，大多数前瞻性随机对照试验显示生存率几乎没有益处。本研究的目的是确定rFVIIa是否可以在军事实践的临床相关时间尺度内增加生存时间，并减少不可压缩动脉出血模型中的失血量。次要目的是确定扩张性复苏与正常血压复苏对rFVIIa有效性的影响。
方法
将终末麻醉的大型白色猪随机分配至4个给药组之一。所有动物均接受了占总估计血量40%的受控出血。他们静脉注射rFVIIa（180 μ g/kg）或安慰剂（生理盐水0.3 mL/kg），并在肾下主动脉中创建4至5 mm纵向切开术，然后开始用0.9%生理盐水复苏至两个目标收缩期动脉血压（SBP）之一：110 mm Hg（正常血压）或80 mm Hg（舒张压）。分组大小如下：安慰剂/血压正常（6）、安慰剂/利尿剂（7）、rFVIIa/血压正常（7）和rFVIIa/利尿剂（7）。在复苏开始后监测存活最多6小时。
结果
rFVIIa与接受药物治疗的动物的存活时间显著延长相关（rFVIIa与安慰剂的平均[95%置信区间]分别为214 [79-349]分钟与35 [19-52]分钟，p = 0.03 Peto对数秩检验）。在血压正常的治疗组中，rFVIIa组和安慰剂组的生存时间无显著差异（分别为128 [6-249] vs. 40 [15-66]分钟，p = 0.27）。rFVIIa和扩张治疗均与未控制出血量减少相关。没有证据表明不适当的血管内血栓或微血栓与rFVIIa的使用相关。
结论
在动脉出血模型中，rFVIIa联合扩张性复苏可延长存活时间并减少出血。生存时间的增加是临床相关的军事战场伤员后送外科治疗。
BACKGROUND
Hemorrhage is the leading cause of death in battlefield casualties and the second leading cause of death after civilian trauma. Evacuation time for military casualties to surgical care can be prolonged and improved hemostasis could greatly reduce mortality. There are several anecdotal reports that recombinant activated factor VII (rFVIIa) may arrest uncontrolled bleeding after trauma. However, the majority of prospective randomized controlled trials show little benefit in survival. The aim of this study was to determine whether rFVIIa could increase survival time within a clinically relevant time scale for military practice and reduce the volume of blood loss in a model of incompressible arterial hemorrhage. A secondary aim was to determine the effects of hypotensive versus normotensive resuscitation on the effectiveness of rFVIIa.
METHODS
Terminally anaesthetized Large White pigs were randomly allocated to one of four treatment groups. All animals received a controlled hemorrhage of 40% of the total estimated blood volume. They were given either rFVIIa (180 microg/kg) or placebo (saline 0.3 mL/kg) intravenously and a 4 to 5 mm longitudinal aortotomy created in the infra renal aorta before resuscitation commenced with 0.9% saline to one of two target systolic arterial blood pressures (SBPs): 110 mm Hg (normotensive) or 80 mm Hg (hypotensive). Group sizes were as follows: placebo/normotensive (6), placebo/hypotensive (7), rFVIIa/normotensive (7), and rFVIIa/hypotensive (7). Survival was monitored for a maximum of 6 hours after the onset of resuscitation.
RESULTS
rFVIIa was associated with a significantly prolonged survival time in animals managed hypotensively (214 [79-349] vs. 35 [19-52] minutes mean [95% confidence interval] rFVIIa vs. placebo, p = 0.03 Peto log rank test). There was no significant difference in survival time between those given rFVIIa and placebo in groups managed normotensively (128 [6-249] vs. 40 [15-66] minutes respectively, p = 0.27). Both rFVIIa and hypotensive management were associated with reduced uncontrolled hemorrhage volumes. There was no evidence of inappropriate intravascular thrombi or microthrombi associated with the use of rFVIIa.
CONCLUSIONS
rFVIIa, combined with hypotensive resuscitation, can increase survival time and reduce hemorrhage in a model of arterial hemorrhage. The increase in survival time is clinically relevant for military evacuation of battlefield casualties to surgical care.
DOI：
10.1097/00005373-199502000-00006
发表时间：
1995-02-01
影响因子：
--
作者：
SAUAIA, A;MOORE, FA;PONS, PT
通讯作者：
PONS, PT