血原补充剂可以改善炎症性保留创伤性血胸的溶解
Elizabeth R Maginot1, Flobater I Gawargi, Ernest E Moore
1From the Division of Acute Care Surgery, Department of Surgery (E.R.M., F.I.G., G.E.V., T.B.M., K.S.S., D.H., J.F.T., O.O.S., C.H.E., E.C., A.J.K., G.D.L., M.M., J.V., M.R.C., Z.M.B., R.H., C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery, Ernest E Moore Shock Trauma Center, Denver Health, Denver; Department of Surgery (E.E.M., J.G.C.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Cellular and Integrative Physiology (C.M.W., C.D.B.), University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (H.B.M.), AdventHealth Porter, Denver; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (P.K.M.), University of Colorado Anschutz Medical Campus, Aurora; Sauaia Statistical Solutions, LLC (A.S.), Denver, Colorado; Hunter College (I.M.B.), Department of Biological Sciences, New York, New York; and Division of Acute Care Surgery, Trauma and Critical Care, Department of Surgery (M.B.Y.), Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston; Departments of Biological Engineering (M.B.Y.), and Biology (M.B.Y.), Center for Precision Cancer Medicine, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts.
留住的血胸 (rHTX) 涉及到腔空间的持续血液,导致炎症和等离子素耗尽. 这会损害纤维解质,这表明脑内纤维解质治疗的效果可能不如以前想象的那么好.
科学领域:
- 创伤外科手术是什么
- 胸腔医学是多发性医学.
- 血液静止和血栓形成
背景情况:
- 留住的血胸 (rHTX) 是肺空间的血液,持续超过72小时.
- 胸腔管的初始治疗往往失败,需要手术.
- 脑内膜纤维解药疗法 (IPFT) 的失败率很高 (>20%).
研究的目的:
- 为了研究rHTX.的炎症环境.
- 为了确定等离子体枯竭是否会损害rHTX中的纤维解.
- 评估IPFT在rHTX中的疗效.
主要方法:
- 从创伤患者收集血胸液和血 (n=19).
- 测量了弹性酶和塑原激活剂抑制剂1 (PAI-1) 的水平.
- 评估了等离子素含量和通过西部斑块的降解.
- 使用血栓溶解试验评估的纤维溶解潜力,含有或不含补充等离子体.
主要成果:
- 与血相比,rHTX中的弹性酶水平显著更高.
- 在rHTX.中观察到低等离子素水平和炎症降解的证据.
- 补充的等离子素改善了rHTX中的凝块溶解时间.
- 在rHTX中,PAI-1似乎没有显著抑制tPA.
结论:
- 留住的血胸形成了一个炎症环境,耗尽了等离子素,降低了纤维溶解能力.
- 对tPA的PAI-1抑制不太可能是rHTX中IPFT失败的原因.
- 这些发现挑战了IPFT对rHTX的作用,并支持手术干预;对于手术候选人来说,等离子素补充值得进一步研究.
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