琥珀酰明胶影响凝血酶生成的机制  

Succinyl gelatin has effect on thrombin generation

作　　者：侯瑞礁 黄春梅 金善良[1] HOU Ruijiao;HUANG Chunmei;JIN Shanliang(Department of Anesthesiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011, China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海200011

出　　处：《外科理论与实践》2018年第6期542-545,共4页Journal of Surgery Concepts & Practice

基　　金：上海市卫生和计划生育委员会面上项目(201440409);上海交通大学医学院科研基金(14XJ10016)

摘　　要：目的:探讨琥珀酰明胶(gelatin, GEL)影响机体凝血酶生成的相关机制。方法 :选取12例健康志愿者,采集外周静脉血,分别加入GEL(GEL组)和乳酸钠林格液(lactated Ringer's solution, LR)(LR组)。以基础值、10∶2、10∶4和10∶6的稀释度进行血液稀释。观察GEL和LR对凝血因子活性和血小板功能的影响。结果:两组各凝血因子活性随着稀释度增加而明显下降。但在相同稀释条件下,两组间各凝血因子活性差异无统计学意义。GEL降低血小板P选择素的表达,但不影响血小板糖蛋白Ⅱb/Ⅲa受体和血小板磷脂酰丝氨酸的表达以及血小板体积。GEL对血小板计数的影响也与LR一致。结论:GEL通过降低血小板P选择素的表达,影响凝血酶在爆发阶段的生成,导致凝血酶生成的速度和峰值均降低。Objective To investigate the effect of succinyl gelatin(GEL) on thrombin generation and the mechanisms in vitro. Methods Blood samples were obtained from 12 healthy adult volunteers and were diluted with succinyl gelatin(GEL group) and sodium lactated Ringer's solution(LR group). The dilution ratios of citrated blood volume to plasma sub-stitute volume were baseline value, 10 ∶2, 10 ∶4 and 10 ∶6. The effect of GEL and LR on blood coagulation factors and platelet function was studied. Results The blood coagulation factor activity decreased significantly when dilution degree increased in both groups. However, there were no significant differences of blood coagulation factor activity between 2 groups. GEL decreased the expression of platelet P-selectin, while expression of phosphatidylserine, glycoprotein Ⅱb/Ⅲa and platelet volume were not significantly changed in both GEL group and LR group. GEL had also no effect on amount of platelet. Conclusions Gelatin decreased the expression of P-selectin on platelet surface and frustrated the explosion stage of thrombin generation, leading to impairment of velocity and peak of thrombin generation.

关 键 词：明胶 凝血酶 血小板 血液稀释 

分 类 号：R619.1[医药卫生—外科学]