Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model
Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model
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DOI：
10.1097/01.ta.0000220373.29743.69
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发表时间：
2006-07-01
影响因子：
--
通讯作者：
Schreiber, Martin A.
中科院分区：
文献类型：
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作者：
Kiraly, Laszlo N.;Differding, Jerome A.;Schreiber, Martin A.
背景：乳酸林格液(LR)和生理盐水(NS)在许多创伤中心可以互换使用。本研究的目的是比较LR和NS对失控出血性猪模型凝血功能的影响。我们假设用LR复苏会产生高凝状态。方法：20只麻醉的猪，体重35+/-3 kg，接受中心静脉和动脉插管、剖腹手术和脾切除。脾切除后，盲法注射相当于每克脾重量3毫升的研究液。造成V级肝损伤，动物在未复苏的情况下出血30分钟。动物被用各自的研究液复苏，并保持在损伤前的地图上，直到研究结束。分别于基线(0‘)和研究结束(120)采集凝血酶原时间(PT)、部分凝血活酶时间(PTT)和纤维蛋白原(Fg)。分别于伤后0‘、30’、60‘、90’和120‘进行血栓弹力成像。结果：基础组R值、PT、M和纤维蛋白原无显著差异。基础R值与30min R值比较，差异无统计学意义(p=0.17)。使用LR后，R值从基线显著降低至30分钟(p=0.02)。60min时，LR组R值较NS组短(p=0.002)，Alpha角、最大波幅和凝血指数较NS组高(p<0.05)。研究结束时，LR组的R值、PT和PTT较NS组显著降低(p<；0.05)。NS组的总出血量明显高于LR组(p=0.009)。结论：在失血性休克中，用LR复苏比用NS复苏的高凝状态更好，失血量更少。
Background: Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability.Methods: There were 20 anesthetized swine (35 +/- 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromhoplastin Time (PTT), and fibrinogen were collected at baseline (0') and study end (120). Thrombelastography was performed at 0' and postinjury at 30', 60', 90', and 120'.Results: There were no significant baseline group differences in R value, PT, M, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p < 0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p < 0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009).Conclusions: This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.