体外模拟大量失血模型输血前凝血功能研究  

In vitro study of coagulation function with mass blood loss model before transfusion

作　　者：罗圆圆[1] 汪德清[1] 周玲玲[1] 庄远[1] LUO Yuanyuan;WANG Deqing;ZHOU Lingling;ZHUANG Yuan(Department of Transfusion,PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院输血科,北京100853

出　　处：《中国输血杂志》2018年第11期1237-1239,共3页Chinese Journal of Blood Transfusion

基　　金：军队医学科技青年培育项目(14QNP106)

摘　　要：目的选择体外模拟大量失血模型的输血前凝血功能检测指标,为建立指导合理输血策略提供依据。方法自2017年3月2日在解放军总医院选择8名体检合格的健康献血者采集血液标本。按正常成人血容量建立失血量40%(M_1)和60%(M_2)的血液稀释模型,体外模拟大出血患者不同程度血容量丢失及输血前以晶体和胶体液补充血容量。对原始标本和2个大量失血模型做血常规、基础凝血功能、主要凝血因子活性、血栓弹力图(TEG)检测并做统计学分析。结果 M_1的TEG各主要参数都在正常范围值内,提示尚能维持稳定凝血块,但K值均值延长接近正常值上限(参考值范围1—3 min),MA值均值则落到了正常值下限(参考值范围50—70 mm);而血小板计数(Plt)降为(102. 25±15. 07)×10~9/L,纤维蛋白原(Fib)浓度下降为(1. 18±0. 27) g/L(P<0. 01),主要凝血因子活性约为不及基线活性的一半,而PT和APTT则已明显延长至(20. 36±1. 48) s和(58. 46±4. 81) s(P<0. 01)。M_2的TEG检测只有R值尚维持正常,K值明显延长至(4. 63±0. 86) min,MA值降低至(42. 83±4. 80) mm(P<0. 05),提示需要补充纤维蛋白原和血小板制剂;而Plt降为(85. 63±15. 22)×10~9/L,Fib进一步下降为(0. 95±0. 25) g/L(P<0. 01),主要凝血因子活性不及初始(基线)活性的4成,尤其是FⅤ和FⅧ活性下降至3成左右; PT、APTT的延长更加明显(P<0. 01)。结论Plt和Fib变化符合TEG的MA、K值的变化趋势;面对大出血患者,临床应该重视Plt和Fib监测。Objective To evaluate the coagulation function of mass blood loss models and find effective and simple laboratory parameters for patients with major bleeding,which could provide a improved guide for clinical transfusion. Methods Dilution models were established representing blood loss of different ratios(M1,40% and M2,60%) in vitro and correspondingly replaced with crystalloid and colloid solution. The blood routine,basic coagulation function,major clotting factor activities and thromboelastography(TEG) of each model and baseline were measured and analyzed. Results In the M1 model,the mean values of R,K,Alpha angle and MA of TEG were all within the normal ranges. The average K value was(2. 91±0. 79) min(normal range 1-3 min) and MA value was 52. 46±5. 97mm(normal range 50-70 mm). Accordingly platelet count was(102. 25±15. 07) × 10^9/L and fibrinogen concentration was(1. 18± 0. 27) g/L(P< 0. 01). Compared to baseline,the activity of major coagulation factors went down to 44%. PT and APTT prolonged significantly with a value of(20. 36±1. 48) s and(58. 46±4. 81) s respectively(P<0. 01). In the M2 models,the R value was normal. The K value prolonged to(4. 63±0. 86) min and MA value reduced to(42. 83±4. 80) mm(P<0. 05),which hindered fibrinogen and platelets transfusion. Accordingly,platelet count was(85. 63±15. 22) ×10^9/L and fibrinogen concentration was(0. 95±0. 25) g/L(P<0. 01). Compared to baseline,the activity of major coagulation factors went down to 38%. PT and APTT further prolonged(P<0. 01). Conclusion The changes of platelets count and fibrinogen concentration are in accordance with MA value and K value,which should be monitored in mass blood loss procedures.

关 键 词：大量失血 凝血功能 血栓弹力图 血小板 纤维蛋白原 

分 类 号：R446.111[医药卫生—诊断学] R619.1[医药卫生—临床医学]