Correction of acute traumatic coagulopathy with small-volume 7.5% NaCl adenosine, lidocaine, and Mg2+ occurs within 5 minutes: A ROTEM analysis
Correction of acute traumatic coagulopathy with small-volume 7.5% NaCl adenosine, lidocaine, and Mg2+ occurs within 5 minutes: A ROTEM analysis
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DOI：
10.1097/ta.0000000000000587
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发表时间：
2015-04-01
影响因子：
3.4
通讯作者：
Dobson, Geoffrey P.
中科院分区：
文献类型：
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作者：
Letson, Hayley L.;Dobson, Geoffrey P.
背景：急性创伤性凝血功能障碍是出血性休克后死亡率和发病率的主要原因。我们的目的是使用ROTEM检查小体积7.5%NaCl与腺苷、利多卡因和Mg 2+（ALM）复苏对严重失血性休克大鼠模型中凝血障碍纠正时间的影响。雄性大鼠（300-450 g，n = 64）随机分配至（1）基线，（2）假手术，（3）出血，（4）休克，（5）7.5%NaCl 5分钟，（6）7.5%NaCl + ALM 5分钟，（7）7.5%NaCl处理60分钟，或（8）7.5%NaCl与ALM处理60分钟（所有n = 8）。为了复苏，在有和没有ALM的情况下静脉推注0.3 mL 7.5%氯化钠（每组n = 8）。结果：出血后凝血酶原时间（PT）和活化部分凝血活酶时间（aPTT）增加约4 ~ 6倍，ROTEM显示低凝状态。休克60分钟后，没有可持续的血栓形成。7.5% NaCl使平均动脉压（MAP）在5分钟时升高至46 +/- 2 mm Hg，并在EXTEM中产生弱凝块，所有试验中均伴有纤维蛋白溶解亢进。在60分钟时，7.5% NaCl未能维持MAP（43 +/- 5 mm Hg）并产生活凝块。与此直接相反，在5分钟时，7.5%NaCl与ALM使MAP复苏至64 +/-3 mm Hg，校正PT和aPTT，并产生完全形成的EXTEM和FIBTEM凝块。60分钟时，MAP为69 +/- 5 mm Hg，PT和aPTT完全校正，α角、血凝块振幅（A10、A30）以及血凝块硬度和弹性与基线相比无显著差异。ALM凝块溶解在60分钟是显着低于出血，休克，或7.5%NaCl，表明保护对hyperfibrinolysis.CONCLUSION：小容量7.5%NaCl未能复苏和纠正凝血功能障碍。相比之下，7.5%NaCl与ALM在5分钟时使MAP复苏并校正凝血病，在60分钟时进一步改善凝块动力学、繁殖和硬度。ALM完全逆转纤溶亢进至基线。讨论了可能的机制。版权所有（C）2015威科医疗集团All rights reserved.
BACKGROUND: Acute traumatic coagulopathy is a major contributor to mortality and morbidity following hemorrhagic shock. Our aim was to examine the effect of small-volume 7.5% NaCl with adenosine, lidocaine, and Mg2+ (ALM) resuscitation on the timing of correction of coagulopathy in the rat model of severe hemorrhagic shock using ROTEM.METHODS: Male rats (300-450 g, n = 64) were randomly assigned to (1) baseline, (2) sham, (3) bleed, (4) shock, (5) 7.5% NaCl for 5 minutes, (6) 7.5% NaCl with ALM for 5 minutes, (7) 7.5% NaCl for 60 minutes, or (8) 7.5% NaCl with ALM for 60 minutes (all n = 8). For resuscitation, 0.3-mL intravenous bolus of 7.5% NaCl was administered with and without ALM (n = 8 each group). Hemodynamics and coagulopathy were assessed.RESULTS: After hemorrhage, prothrombin time (PT) and activated partial thromboplastin time (aPTT) increased approximately four to six times, and ROTEM indicated hypocoagulopathy. After 60-minute shock, no sustainable clots could form. 7.5% NaCl increased mean arterial pressure (MAP) to 46 +/- 2 mm Hg at 5 minutes and generated a weak clot in EXTEM with hyperfibrinolysis in all tests. At 60 minutes, 7.5% NaCl failed to sustain MAP (43 +/- 5 mm Hg) and generate a viable clot. In direct contrast, 7.5% NaCl with ALM at 5 minutes resuscitated MAP to 64 +/- 3 mm Hg, corrected PT and aPTT, and generated fully formed EXTEM and FIBTEM clots. At 60 minutes, MAP was 69 +/- 5 mm Hg, PT and aPTT were fully corrected, and alpha angle, clot amplitudes (A10, A30), as well as clot firmness and elasticity were not significantly different from baseline. ALM clot lysis at 60 minutes was significantly less than bleed, shock, or 7.5% NaCl, indicating protection against hyperfibrinolysis.CONCLUSION: Small-volume 7.5% NaCl failed to resuscitate and correct coagulopathy. In contrast, 7.5% NaCl with ALM resuscitated MAP and corrected coagulopathy at 5 minutes, with further improvements at 60 minutes in clot kinetics, propagation, and firmness. ALM fully reversed hyperfibrinolysis to baseline. The possible mechanisms are discussed. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.