Self-Propelled Dressings Containing Thrombin and Tranexamic Acid Improve Short-Term Survival in a Swine Model of Lethal Junctional Hemorrhage.
Self-Propelled Dressings Containing Thrombin and Tranexamic Acid Improve Short-Term Survival in a Swine Model of Lethal Junctional Hemorrhage.
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DOI：
10.1097/shk.0000000000000646
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发表时间：
2016-09
期刊：
影响因子：
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通讯作者：
Kastrup CJ
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文献类型：
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作者：
Baylis JR;St John AE;Wang X;Lim EB;Statz ML;Chien D;Simonson E;Stern SA;Liggins RT;White NJ;Kastrup CJ
出血是创伤中可预防的死亡的主要原因，而来自不可压缩的交界解剖部位的出血尤其难以控制。目前的标准是QuikClot战斗纱布包装，需要3分钟的压缩。我们已经创造了一种新型的含有碳酸钙微粒的敷料，这种敷料可以分散和自我推进，以对抗流动的血液。我们用凝血酶和氨甲环酸负载这些微粒，并在没有伤口压迫的猪动脉出血模型中测试它们的有效性。麻醉未成熟母猪行5 mm股动脉切开术，造成严重交界处出血。创面填充以高岭土为基础的QuikClot战斗纱布(KG)、含有质子化氨甲环酸(PTG)的推进凝血酶微粒(PTG)或含有非质子化氨甲环酸(NPTG)的相同凝血酶微粒的非推进制剂。包扎后伤口未受压。每只大鼠均注射15毫升/公斤的羟乙基淀粉溶液，然后根据降压需要注射乳酸林格氏溶液(最大剂量：100毫升/公斤)，持续3小时。PTG组(3小时存活率：8/8,100%)明显高于KG组(3/8，37.5%)和NPTG组(2/8，25%)(p<；0.01)。与NPTG相比，PTG动物维持较低的血清乳酸和较高的血红蛋白浓度(p<；0.05)，这表明PTG降低了随后失血性休克的严重程度。然而，存活动物的总失血量、乳酸林格氏输液量和平均动脉压在两组之间没有差异(p>；0.05)。因此，在这个交界性动脉出血的猪模型中，含有自行式、促血栓形成微粒的纱布可以提高存活率，并且在不加压的情况下可以改善失血性休克的两个指标，这表明这种能力可能使不可压缩的交界性伤口得到更好的治疗。
Hemorrhage is the leading cause of preventable death in trauma, and hemorrhage from noncompressible junctional anatomic sites is particularly difficult to control. The current standard is QuikClot Combat Gauze packing, which requires 3 min of compression. We have created a novel dressing with calcium carbonate microparticles that can disperse and self-propel upstream against flowing blood. We loaded these microparticles with thrombin and tranexamic acid and tested their efficacy in a swine arterial bleeding model without wound compression. Anesthetized immature female swine received 5 mm femoral arteriotomies to induce severe junctional hemorrhage. Wounds were packed with kaolin-based QuikClot Combat Gauze (KG), propelled thrombin-microparticles with protonated tranexamic acid (PTG), or a non-propelling formulation of the same thrombin-microparticles with non-protonated tranexamic acid (NPTG). Wounds were not compressed after packing. Each animal then received one 15 mL/kg bolus of hydroxyethyl starch solution followed by Lactated Ringer’s as needed for hypotension (maximum: 100 mL/kg) for up to 3 hours. Survival was improved with PTG (3-hr survival: 8/8, 100%) compared to KG (3/8, 37.5%) and NPTG (2/8, 25%) (p<0.01). PTG animals maintained lower serum lactate and higher hemoglobin concentrations than NPTG (p<0.05) suggesting PTG decreased severity of subsequent hemorrhagic shock. However, total blood loss, Lactated Ringer’s infusion volumes, and mean arterial pressures of surviving animals were not different between groups (p>0.05). Thus, in this swine model of junctional arterial hemorrhage, gauze with self-propelled, pro-thrombotic microparticles improved survival and two indicators of hemorrhagic shock when applied without compression, suggesting this capability may enable better treatment of non-compressible junctional wounds.