Acute coagulopathy in a porcine venous hemorrhage and ischemia reperfusion model

被引：12

作者：

Hatch, Quinton ^{[1
]}

Debarros, Mia ^{[1
]}

Eckert, Matthew ^{[1
]}

Satterly, Steven ^{[1
]}

Nelson, Daniel ^{[1
]}

Porta, Rees ^{[1
]}

Lesperance, Richard ^{[1
]}

Long, William ^{[2
]}

Martin, Matthew ^{[1
,2
]}

机构：

[1] Madigan Army Med Ctr, Dept Surg, Tacoma, WA 98431 USA

[2] Legacy Emanuel Med Ctr, Dept Surg, Portland, OR 97227 USA

来源：

AMERICAN JOURNAL OF SURGERY | 2014年 / 207卷 / 05期

关键词：

Trauma; Coagulopathy; Porcine; PROTHROMBIN COMPLEX CONCENTRATE; TRAUMA; SHOCK; THROMBELASTOGRAPHY; TIME; RESUSCITATION; HYPOTHERMIA; ADMISSION; ACIDOSIS; INJURY;

D O I：

10.1016/j.amjsurg.2013.12.008

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

BACKGROUND: Injury-related coagulopathy is a complex process. We analyzed coagulation in a swine model of shock using rotational thromboelastometry (ROTEM). METHODS: Forty-eight swine underwent laparotomy, 35% hemorrhage, supraceliac aortic cross-clamp, then reperfusion and resuscitation. ROTEM measurements and standard labs were taken at baseline and 6 hours into resuscitation. RESULTS: Clot formation time (98 vs 53 seconds, P = .001) and international normalized ratio (1.67 vs 1.01, P < .001) were prolonged after resuscitation. Maximum clot firmness (61 vs 72 mm, P < .001) and fibrinogen levels (94 vs 165, P < .001) declined significantly during resuscitation. Despite decreased fibrinogen levels, there was no significant increase in fibrinolysis as measured by maximum lysis (3.9% vs 3.8%, P = .99). CONCLUSIONS: ROTEM demonstrated the development of an acute coagulopathy. The most significant impacts on coagulopathy were seen with clot initiation and fibrin polymerization. Clot strength decreased over time, although there was little impact on clot breakdown because of fibrinolysis. Published by Elsevier Inc.

引用

页码：637 / 641

页数：5

共 23 条

[1] Hemostatic and Pharmacologic Resuscitation: Results of a Long-Term Survival Study in a Swine PolyTrauma Model DISCUSSION [J].

Maier, Ronald V. ;

Alam, Hasan B. .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2011, 70 (03) :644-645

[2] Acute traumatic coagulopathy [J].

Brohi, K ;

Singh, J ;

Heron, M ;

Coats, T .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 54 (06) :1127-1130

[3] ASSOCIATION FOR ACADEMIC SURGERY Microarray and Functional Cluster Analysis Implicates Transforming Growth Factor Beta1 in Endothelial Cell Dysfunction in a Swine Hemorrhagic Shock Model [J].

Causey, Marlin Wayne ;

Hoffer, Zachary S. ;

Miller, Seth L. ;

Huston, Laurel J. ;

Satterly, Steve A. ;

Martin, Matthew ;

Stallings, Jonathan D. .

JOURNAL OF SURGICAL RESEARCH, 2011, 170 (01) :120-132

[4] Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration [J].

Cotton, Bryan A. ;

Harvin, John A. ;

Kostousouv, Vadim ;

Minei, Kristin M. ;

Radwan, Zayde A. ;

Schoechl, Herbert ;

Wade, Charles E. ;

Holcomb, John B. ;

Matijevic, Nena .

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2012, 73 (02) :365-370

[5] Rapid Thrombelastography Delivers Real-Time Results That Predict Transfusion Within 1 Hour of Admission [J].

Cotton, Bryan A. ;

Faz, Gabriel ;

Hatch, Quinton M. ;

Radwan, Zayde A. ;

Podbielski, Jeanette ;

Wade, Charles ;

Kozar, Rosemary A. ;

Holcomb, John B. .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2011, 71 (02) :407-414

[6]

Darlington DN, 2012, INT J BURNS TRAUMA, V2, P145

[7] Prothrombin complex concentrate vs fresh frozen plasma for reversal of dilutional coagulopathy in a porcine trauma model [J].

Dickneite, G. ;

Pragst, I. .

BRITISH JOURNAL OF ANAESTHESIA, 2009, 102 (03) :345-354

[8]

HANNON JP, 1992, SWINE AS MODELS IN BIOMEDICAL RESEARCH, P197

[9] Preclinical models of traumatic, hemorrhagic shock [J].

Hauser, CJ .

SHOCK, 2005, 24 :24-32

[10] The Coagulopathy of Trauma: A Review of Mechanisms [J].

Hess, John R. ;

Brohi, Karim ;

Dutton, Richard P. ;

Hauser, Carl J. ;

Holcomb, John B. ;

Kluger, Yoram ;

Mackway-Jones, Kevin ;

Parr, Michael J. ;

Rizoli, Sandro B. ;

Yukioka, Tetsuo ;

Hoyt, David B. ;

Bouillon, Bertil .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2008, 65 (04) :748-754

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