酸血症时凝血功能变化的研究  

Study on change of coagulation function during acidosis

作　　者：范铭兴[1] 嵇武[2] 丁博文[1] 杨荣[1] 刘兴东[2] 丁凯[2] 黎介寿[2] 

机构地区：[1]南京大学医学院,江苏南京210029 [2]南京军区南京总医院普通外科解放军普通外科研究所,江苏南京210002

出　　处：《中国现代医学杂志》2011年第23期2821-2824,2830,共5页China Journal of Modern Medicine

基　　金：全军医药卫生科研专项基金(No:08Z007)

摘　　要：目的观察酸血症时凝血功能变化,对比不同检测方法对酸血症时凝血功能的诊断价值。方法将12只家猪分为对照组和酸血症组,在控制性放出实验动物总血容量的35%后,阻断其自主呼吸并配合呼吸机制造酸血症模型。测定基础时间点和酸血症模型制作成功180min后血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)以及血栓弹力图仪(TEG)各项参数,并行对照分析。结果与基础值相比,180min后实验组血乳酸浓度上升了220%,血小板数量降低了30%,血浆纤维蛋白浓度降低了27%(P<0.05),实验组PT、APTT和TT均无显著变化。TEG各项参数中,R时间无显著变化,K时间出现显著延长,α角和MA值均显著减小(P<0.05)。结论在酸血症时,实验动物出现血低凝状态,其原因与血凝块合成速率下降和血凝块强度的降低有关。TEG在创伤合并酸血症时对凝血功能检测的敏感性优于PT、APTT等方法。【Objective】 To observe the change of coagulation in aicdosis,and evaluate the clinical significance of different examination monitoring during acidosis in pigs.【Methods】 Pigs（n =12） were randomized into two groups of six animals each： sham control and acidosis.Acidosis group was induced by bleeding 35% of total blood volume followed by inhibiting spontaneous breath and regulating ventilate volume by ventilator.Coagulation function was assessed by PT,APTT,TT,and TEG from blood samples taken at baseline and 180 min after acidosis model completed.【Results】 Compared with sham control group,the lactate of acidosis group increased 220%,platelets reduced 30% and fibrinogen reduced 27% after acidosis model completed（all P 0.05）.There were no significant changes in TT,PT or APTT and the initial clotting time（R） in TEG by acidosis at 180 min（all P 0.05）.Acidosis prolonged the clot formation time（K）,and decreased clotting rapidity（α） and clot strength（maximum amplitude ）,（all P 0.05）.【Conclusion】 The hyper-coagulation status were induced by hemorrhage with acidosis,the reasons behind it are related with the slower speed of blood clot,and the drop in strength of blood clot.The TEG showed better sensibility than PT,APTT and TT in this statue.

关 键 词：创伤 酸血症 凝血机制障碍 血栓弹力图描记仪 

分 类 号：R64[医药卫生—外科学]