等容血液稀释对出血性休克家兔凝血酶生成的影响  

Effects of normovolemic hemodilution on thrombin generation of hemorrhage shock rabbits

作　　者：沈亮[1] 陆志俊[2] 陈恳[1] 孙继辉[1] 罗艳[2] 于布为[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院麻醉科,上海市200020 [2]上海交通大学医学院附属瑞金医院麻醉科

出　　处：《临床麻醉学杂志》2013年第2期171-174,共4页Journal of Clinical Anesthesiology

基　　金：上海市卫生局科研课题(2008116)

摘　　要：目的探讨等容血液稀释对家兔出血性休克时凝血酶生成的影响。方法成年雄性新西兰家兔24只,随机均分为羟乙基淀粉组(V组)、琥珀酰明胶组(G组)、复方乳酸钠组(R组)和对照组(C组),V、G和R组分别输注羟乙基淀粉130/0.4、琥珀酰明胶和复方乳酸钠,C组不行血液稀释。血液稀释完成后开腹,切除2cm3肝脏组织后立即缝合腹腔皮肤。10min后,V、G、R三组开始回输自体血,C组回输复方乳酸钠。记录血液稀释前(T0)、血液稀释后(T1)、切除肝脏组织后10min(T2)、40min(即自体血回输完成即刻,T3)、70min(T4)、130min(T5)时实验兔的MAP和HR,抽取动脉血样行凝血酶生成试验,记录T0～T5时凝血酶的生成延迟时间、峰值、达峰时间、生成潜力值,并观察肝出血自体血复苏的130min内家兔的生存时间和失血量。结果 G组家兔在T2时、V组在T1～T5时、R组在T1、T2时MAP明显低于T0时(P<0.05),T2时G、V和R组MAP明显低于C组(P<0.05)。V组家兔在T1～T5时HR明显慢于T0时(P<0.05)。T3时R组家兔的凝血酶生成延迟时间和T3、T4时凝血酶达峰时间明显长于T0时(P<0.05),T3时V组的凝血酶峰值明显低于T0时(P<0.05);T1～T5时V组和R组的凝血酶生成潜力值明显低于T0时(P<0.05)。T4时V组和R组的凝血酶生成潜力值明显低于C组(P<0.05),T3、T4时G组凝血酶达峰时间明显长于V组(P<0.05)。结论对等容血液稀释的家兔出血性休克模型,羟乙基淀粉130/0.4对凝血功能的影响较琥珀酰明胶和晶体强。Objective The present study was performed to investigate the effects of normovolemic hemodilution on thrombin in hemorrhage shock rabbits. Methods Twenty four male adult New Zealand rabbits were randomly divided into four groups： group V （hydroxyethyl starch 130/0.4）, group G （gelofusine）, group R （ringer lactate） and group C （control group） （n= 6 for each group）. After normovolemic hemodilntion, about 2 crn3 hepatic tissue was cut off and incision was sutured. After 10 rain, autologous blood resuscitation were performed in groups V, G and R, while ringer lactate was infused in group C for 30 mirL MAP and HR were recorded before hemodilution （To）, after hernodilution （T1）, 10 min （T2） ,40 min （T3） ,70 rain （T4）, 130（T5 ） rain after cutting the liver tissue Blood samples were collected for thrombin test （lagtime, Peak, ETP, ttPeak） at T0-T5. Survival time and blood loss were monitored continuously for 130 min after hepatic hemorrhage Results Compared with To, MAP in group G at T2, group V at T1-T5 and group R at T1 ,T2 were significantly decreased（P〈0. 05）, HR in goup V at T1-T5 were slower（P〈0. 05）. Compared with group C, MAP in the other groups were obviously decreased at T2 （P〈0. 05）. Compared with To, the time of thrombin generated at T3 and time to peak at T3, T4 were increased in group R , thrombin peak at Ta in group V was deceased, the generated potential at T1-T5 in groups V and R were lower （P〈0. 05）. The generated potential at T4 in groups V and R were lower than that in group C, and time to peak at Ta, T4 in group G were more than that in group V（P〈0. 05）. Condmion Hydroxyethyl starch 130/0. 4 has a greater influence on coagulation function （peak value and ETP） than Gelofusine and Ringer lactate in normovolemic dilution hemorrhage shock rabbits.

关 键 词：等容血液稀释 凝血酶 自体血回输 出血性休克 

分 类 号：R614[医药卫生—麻醉学]