The Impact And Change Of Traumatic Hemorrhagic Shock On Coagulopathy In The Early Phase

Objective:To investigate the impact of the different abdominal injury on coagulation at the traumatic rabbit model.Methods:40 New Zealand white rabbits were randomly divided into four groups and subjected to traumatic or sham operation(group 1/2/3/4). The group 2 was subjected to traumatic hemorrhagic shock and laparotomy. In group 3, traumatic hemorrhagic shock models were established by controlling the carotid artery bloodletting method, and hepatic blunt-impact injury models were established by hitting the exposed liver with steel ball. The group 4 increases intestinal injury and chemical peritonitis caused by faeces compare with group 3. The laparotomy was performed on the group 2. The coagulation were detected by thrombelastography(TEG) before(to) and after trauma at 1,4h(t1,t2), and the blood samples were detected by blood routine examination.Results:1、Laboratory assessments:At the beginning of the experiment, physiologic variables did not differ significantly among the groups. At t1, trauma resulted in a comparable impairment of physiologic variable in three trauma groups (2,3,4) as compared with sham group, with a decrease of temperature, MAP and hemoglobin (p<0.05). Then, the hemoglobin of group 3 and 4 were significantly decrease compared with the group 2 (p< 0.05), and the temperature of group 4 was significantly lower than the group 2 (p<0.05). Lactate increased from baseline in all trauma groups (2,3,4), groups (2,3,4) presenting with a significantly higher than the group 1 (p<0.05). At t2,the temperature, MAP and hemoglobin continuously decreased in the trauma groups (2,3,4) until the end of the observation period, and the temperature of group 4 was significantly decreased compared with the other groups (p<0.05). Lactate values still increased for the trauma groups (2,3,4) compared with sham group, and the ALT of group 3 and 4 were significantly higher than the groups (1,2) (p <0.05). The lactate and NEUT% values were most increased in the group 4, which was significantly different compared with the other groups (p<0.05). Two rabbits in the group 4 died in t 3.7 hours, the blood samples drew from the dying rabbits, and the values incorporated into the results of T2·2、Thromboelastography:Following trauma, R timein group 3 was significantly shorter than that of other groups (p<0.05,t1), and R time continuously shortened in group 3 until the end of the observation period (p< 0.05, t2). R time was significantly prolonged in group 4 compare to groups 1,2, 3(p<0.05, t2). K time in group 4 were significantly longercompare with that in the other groups (p<0.05, t2). No difference among the groups (1,2,3) was observed. Ang significantly decreased in group 4 as compare with groups 2 and 3 (p<0.05, t2). MA in group 4 had significantly decreased relative to that in other groups (p<0.05,t1). Compared with that of the groups (1,2,3), MA continuously decreased following trauma in the group 4 (p<0.05, t2).3、Platelet count:The baseline platelet count results had no difference amongst groups. Following trauma induction, platelet count in the trauma groups 2 and 3 was significantly decreased relative to that in sham group (p< 0.05, t1). At the end of the observation period, all the trauma groups (2,3,4) were significantly decreased as compare with sham group (p<0.05, t2).Conclusion:In this model, isolatedhemorrhagic shock shows no obvious effect oncoagulation, blunt hepatic injury with hemorrhage shows hypercoagulability, while, if together with peritonitis cause by ruptured intestinal, showstendency of hypocoagulability.