The Effect Of PolyCHb Resuscitation Fluid On Blood Coagulation

Background:A large amount of blood loss is very easy to cause hemorrhagic shock.The key measure of its treatment is to perform fluid resuscitation in time to restore circulating blood volume and oxygen supply.Hydroxyethyl starch(HES)is one of the commonly used resuscitation fluids in clinical practice.It plays an important role in the treatment of patients with hemorrhagic shock,but it cannot supply oxygen to tissues and organs.Hemoglobin-based oxygen carriers(HBOCs)are a kind of red blood cell substitutes stem from stroma-free hemoglobin(Hb)by chemical modification and other methods with the function of carrying and releasing oxygen.In the past,foreign clinical studies have found that HBOCs products have side effects such as hypertension,oxidative stress,and coagulation dysfunction.Polymerized human cord hemoglobin(PolyCHb)is one of HBOCs.In the previous study of this group,low-concentration PolyCHb and HES were combined to prepare PolyCHb resuscitation solution,which has a good effect in the treatment of hemorrhagic shock rats.At present,the influence of PolyCHb on blood coagulation has not been explored,so this study mainly focuses on the influence of PolyCHb resuscitation fluid on blood coagulation.Objective:(1)Explore the effects of PolyCHb and HES in PolyCHb resuscitation fluid on coagulation indicators in vitro.(2)Explore the effect of PolyCHb resuscitation fluid on blood coagulation function after resuscitating rats with hemorrhagic shock.Methods:This study is divided into two parts:in vitro and in vivo.Part I:Normal saline,hydroxydthyl starch(HES),two concentrations of free-hemoglobin(FHb),two concentrations of PolyCHb and 36%methemoglobin-containing PolyCHb were used with fresh whole blood or platelet-rich plasma is mixed in equal proportions in vitro,to detect prothrombin time(PT),activated partial thromboplastin time(APTT),partial coagulation factor activity,von Willebrand factor,platelet P-selectin and fibrinolysis.Part Ⅱ:32 SD rats were equally divided into 4 groups:(1)The Sham group:Only vascular intubation,no blood loss and resuscitation;(2)The HES group:After intubation of rats,establish a hemorrhagic shock pressure control model,maintain the shock state for 60 minutes,and then use HES for fluid resuscitation;(3)The 2%PolyCHb group:Model establishment same as HES group and use PolyCHb resuscitation fluid(Hb 20g/L)for resuscitation;(4)The 7%PolyCHb group:Model establishment same as HES group and use PolyCHb resuscitation fluid(Hb 70g/L)for resuscitation.Real-time monitoring of arterial pressure and heart rate after intubation,and recording at basal,shock,0 min after resuscitation and 30 min after resuscitation;blood taken 30 min after resuscitation for detection hemoglobin concentration,hematocrit,platelet count,PT,APTT,thrombin time,fibrinogen,coagulation factor,protein C,tissue factor pathway inhibitor,thromboxane B2,P-selectin,and thromboelastography.Results:An in vitro study,the effect of PolyCHb on blood coagulation is similar to that of HES,mainly for dilution.If the methemoglobin content in PolyCHb is too high,it will have an additional impact on the coagulation function.An in vivo study,the three resuscitation fluids can effectively treat rats with severe hemorrhagic shock.After resuscitation,the blood is diluted,the clotting substances in the plasma are reduced,and the clotting ability is weakened.There was basically no difference in the resuscitation results between the 2%PolyCHb group and the HES group.Compared with the HES group after resuscitation,the 7%PolyCHb group had lower FⅧactivity,weaker platelet function,and higher levels of protein C and tissue factor inhibitors.Conclusion:The effect of low-concentration(Hb 20g/L)PolyCHb resuscitation fluid on blood coagulation is basically the same as that of HES(130/0.4),and the main effect is dilution.Compared with HES(130/0.4),high concentration(Hb 70g/L)PolyCHb has a tendency to inhibit coagulation function.