颈交感神经干离断对脓毒症大鼠凝血和纤溶功能的影响  

Effect of transection cervical sympathetic trunk on blood coagulation and fibrinolysis in septic rats

作　　者：陈勇[1] 童希忠 梁应平[1] 赵红[3] 涂静[4] 胡衍辉[1] 徐国海[1] 

机构地区：[1]南昌大学第二附属医院麻醉科,330006 [2]江西省玉山县妇幼保健院 [3]南昌大学第二附属医院麻醉苏醒室,330006 [4]南昌大学第二附属医院眼科,330006

出　　处：《临床麻醉学杂志》2015年第9期908-911,共4页Journal of Clinical Anesthesiology

摘　　要：目的评价颈交感神经干离断（TCST）对脓毒症大鼠凝血和纤溶功能的影响。方法健康雄性SD大鼠72只,12～15周龄,体重300～350g,采用随机数字表法,将其随机分为三组：假手术组（S组）、脓毒症组（CLP组）和颈交感神经干离断＋脓毒症组（TCST组）,每组24例。CLP组和TCST组采用盲肠结扎穿孔法（CLP）制备大鼠脓毒症模型,TCST组于CLP前行右侧TCST。分别于CLP前即刻（T0）、CLP后2h（T1）、4h（T2）和6h（T3）时每组随机取6只大鼠,经腹主动脉取血,检测血浆TNF-α、凝血酶原时间（PT）、部分活化凝血活酶时间（APTT）、纤维蛋白原（Fib）、抗凝血酶Ⅲ（ATⅢ）、组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制物-1（PAI-1）、D-二聚体（D-D）水平和Plt计数。结果 与T0和S组比较,T1～T3时CLP组和T2、T3时TCST组PT、APTT明显延长,血浆Fib及ATⅢ水平明显降低,血浆TNF-α、t-PA、PAI-1和D-D水平明显升高,Plt计数明显减少（P〈0.05）。与CLP组比较,T1～T3时TCST组PT、APTT明显缩短,血浆Fib及ATⅢ水平明显升高,血浆TNF-α、t-PA、PAI-1和D-D水平明显降低,Plt计数明显增加（P〈0.05）。结论 TCST可改善脓毒症大鼠凝血和纤溶功能,其机制可能与抑制血浆TNF-α水平减轻炎性反应有关。Objective To investgate the effect of transection cervical sympathetic trunk （TCST） on coagulation and fibrinolysis in septic rats. Methods Seventy-two male SD rats, weighing 300-350 g, were equally and randomly divided into 3 groups using a random number table： sham group（group S）, sepsis group（group CLP） and TCST＋ sepsis group（group TCST）. Sepsis model was reproduced by cecum ligation perforation in group CLP and TCST. Right transection of cervical sympathetic trunk were performed before CLP model was successfully induced in group TCST. Six rats were chosen in each group at the time before CLP （T0）and at 2,4 and 6 h after CLP（T1-T3）and arterial blood samples were taken for determination of the levels of plasma tumor necrosis factor-a （TNF-α）, Prothrombin time（PT）, activeated partial thromboplastin time（APTT）, fibrinogen（Fib）, antithrombin Ⅲ （AT Ⅲ ）, tissue-type plasminogen activator （tPA）, plasminogen activator inhibitor type I（PAI-1） ,DDimer（D-D） and the platelet count. Results Compared with To and group S, the PT and APTT were prolonged, plasma Fib, AT m and the platelet count were decreased, and the TNF-α, tPA, PAI-1 and D-Dimer levels were significantly increased in at T1-T3 group CLP and T2 ,T3 in group TCST（P〈0. 05）. Compared with group CLP, the PT and APTT were shorted, plasma Fib, AT m and the platelet count were increased, and the TNF-α, tPA, PAI-1 and D-Dimer levels were significantly decreased at T1-T3 in group TCST（P〈0.05）. Conclusion Transection cervical sympa- thetic trunk can improve the blood coagulation and fibrinolysis in septic rats, inhibition of plasma TNF-α level and attenuated inflammatory responses may be involved in the mechanism.

关 键 词：神经节 交感 交感神经切断术 脓毒症 凝血功能 纤溶功能 

分 类 号：R459.7[医药卫生—急诊医学]