凝血酶原和纤维蛋白原对血浆代用品稀释离体血液凝血功能的影响  

Effects of prothrombin and fibrinogen on coagulation after in vitro hemodilution with plasma substitutes

作　　者：金善良[1] 沈伯雄[2] JIN Shanliang SHEN Boxion(Department of Anesthesiology, Ruijin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China 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瑞金医院北院麻醉科,上海201801 [2]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》2016年第5期427-431,共5页Journal of Surgery Concepts & Practice

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

摘　　要：目的:应用血栓弹性描记图(thromboelastography,TEG),研究凝血酶原复合物(PCC)和纤维蛋白原(Fg)对人工血浆代用品离体血液稀释后凝血功能变化的影响。方法:选取12位健康志愿者,取外周静脉血分别用琥珀酰明胶注射液(GEL)、聚明胶肽注射液(聚明胶肽)、羟乙基淀粉130/0.4(HES130/0.4)和HES200/0.5,以10∶0(未稀释)、10∶2、10∶4和10∶6的稀释度(dilution ratio,DR)稀释枸椽酸钠抗凝血后观察TEG指标变化,以及0.012 U PCC和0.2 mg Fg对10∶4和10:6稀释血液TEG的影响。TEG指标包括反应时间(R)、血凝块形成时间(K)、α角(α)和最大振幅(MA)。结果:GEL组及聚明胶肽组MA值随DR增加而降低。HES130/0.4和HES200/0.5组K值随DR增加而延长,α值随DR增加而减小,MA值随DR增加而降低。Fg干预后,GEL组MA值恢复到基础值水平。TEG显示HES130/0.4组凝血功能明显改善,但DR为10∶6时MA值仍低于基础值(P<0.05)。聚明胶肽及HES200/0.5组TEG指标改善不明显。PCC干预后,HES130/0.4组TEG指标明显改善,但MA值仍低于基础值(P<0.05)。GEL、聚明胶肽及HES200/0.5组TEG指标无明显改善。结论:Fg可消除GEL稀释后血凝块硬度降低的影响。Fg和PCC都可消除HES130/0.4延迟纤维蛋白生成及聚合的影响。但两者对聚明胶肽和HES200/0.5稀释所致的凝血功能变化没有作用。Objective To investigate the effects of prothrombin complex concentrate（PCC） and fibrinogen on coagulation after in vitro hemodilution with artificial plasma substitutes using thrombelastogram（TEG） measurement.Methods Blood samples were obtained from 12 healthy volunteers.Each blood sample was diluted with succinylated gelatin（group GEL）,polygeline（group polygeline）,hydroxyethyl starch 130/0.4（group HES130/0.4） or HES200/0.5（group HES200/0.5）,respectively.The dilution ratios of citrated blood volume to plasma substitute volume were 10∶0（undiluted）,10∶2,10∶4 and10：6.The TEG variables of reaction time（R）,coagulation time（K）,growth angle（α） and maximum amplitude（MA） were determined.The effects of either 0.012 U PCC or 0.2 mg fibrinogen on coagulation in 10∶4 and 10∶6 diluted samples were investigated by TEG.Results MA decreased in group GEL and group polygeline when dilution ratios increased.The prolonged K was observed in group HES130/0.4 and group HES200/0.5 combined with decreased α and MA when dilution ratios increased,MA reached baseline in group GEL with administration of fibrinogen.TEG variables indicated improved coagulation in group HES130/0.4 while MA at dilution ratio 10：6 remained below baseline（P〈0.05） with administration of fibrinogen.There was no obvious change in the TEG variables of group polygeline and group HES200/0.5 after administration of fibrinogen.There was significant improvement of TEG variables after administration of PCC in group HES130/0.4,while MA was still under baseline（P 0.05）.TEG variables were unchanged in group GEL,group polygeline and group HES200/0.5 after administration of PCC.Conclusions Fibrinogen administration could improve the decrease in clot firmness which is produced by hemodilution with GEL.Both fibrinogen and PCC could improve the delayed fibrin formation and build up by HES130/0.4 hemodilution.Neither fibrinogen nor PCC has effect on the changes in coagulation of polygeline or HES200/0.5 hemodiluti

关 键 词：人工血浆代用品 血液稀释 凝血 血栓弹性描记图 离体 

分 类 号：R977.8[医药卫生—药品]