骨盆骨折手术患者自体血液回输血流变学、凝血功能、乳酸、炎性因子变化的影响  

Patients with Pelvic Fractures Surgery Autologous Blood Back to Lose on Hemorrheology, Coagulation Function, Lactic acid, the Influence of Inflammatory Factor Changes

作　　者：张明勋[1] 

机构地区：[1]菏泽市立医院,山东菏泽274030

出　　处：《菏泽医学专科学校学报》2016年第4期1-4,46,共5页Journal of Heze Medical College

摘　　要：目的 探讨骨盆骨折手术患者自体血液回输血流变学、凝血功能、乳酸、炎性因子的变化。方法 骨盆骨折手术患者103例,常规诱导麻醉加硬膜外麻醉,手术前开始链接自血回收装置,抗凝液为肝素盐水。置抗凝液25 ml于储血罐,控制滴速为抗凝液与术中血液收集比1∶（5~7）,负压吸引调整为150~200 mm Hg。自动回收,回收血液4 h内回输。检测不同时间阶段血红蛋白、红红细胞压积、血小板、白细胞、凝血酶原时间、活化部分凝血酶原时间、纤维蛋白原、血流变学、乳酸、白介素-6、肿瘤坏死因子等。应用SPSS20.0软件,所获数据采用方差分析和t检验。结果 血红蛋白：T1与T2~5比及术后各段比较,P均〈0.0005。HCT：T1与T2~5比和T2与T3~5比,P〈均0.0005。白细胞：T1与T2~3比较、T2与T3~5、T3与T4~5比较,P均〈0.0005;T1与T5比较,P〈0.05;T4与T5比较,,P〈0.005。血小板：T1与T2~5比较、T2与T3比较、T3与T4~5比较,P均〈0.0005。心率：T1与T2比较,P〈0.05;T1与T3~5和T2与T3比较,P均〈0.0005;T2与T4比较,P〈0.005;T2与T5、T3与T4~5比较,P均〈0.01。中心静脉压：T1与T2~5比较,P均〈0.0005;T2与T3~5比较,P均〈0.005。平均动脉压：T1与T2、T1与T3、T4与T5比较,P〉0.05;T1与T4~5、T2与T3~5、T3与T4~5比较,P均〈0.0005。凝血酶原时间：T1与T2~5、T2与T4、T3与T4比较,P均〈0.0005;T4与T5比较,P〈0.005。活化部分凝血酶原时间：T1与T2~4、T2与T4~5、T3与T4~5比较,P均〈0.0005;T4与T5比较,P均〈0.05。纤维蛋白原：T1与T2~3、T2与T4~5、T3与T4~5比较,P均〈0.0005;T2与T3比较,P〈0.05。手术前后全血黏度（低切）比较,P〈0.0005。乳酸：T1与T2、T2与T3比较,P均〈0.01;T1与T3~5、T2与T5比较,P均〈0.0005;T2与T3、T3与T5比较,P〈0.05;白介素-6：T1与T2~5、T2与T4~5、T3与T4~5、T4与T5比较,P均〈0.0005;T2与T3比较,P〈0.05。肿瘤坏死因子：T1与T2-5、T2与T3~5、T3与T4~5,T4与T5比较,P均〈0.0005。结论 骨�Objective On patients with pelvic fractures surgery autologous blood transfusion of blood rheology, blood coagulation function back, lactic acid, the change of inflammatory cytokines. Methods 103 patients with pelvic fractures surgery, routine induction of anesthesia and epidural anesthesia, before the operation began to link theblood recy- cling equipment, anticoagulant fluid for heparin saline. 25 ml anticoagulant fluid in ChuXie tank, the control rate of antico- agulationdrops and intraoperatie blood collection than 1：（5 - 7）, pressure suction is adjusted for 150 - 200 mmHg. Au to- matic recovery,recycling within 4 h blood Back to lose. Testing different time phase of hemoglobin, red red blood cells de- posited, platelets, white blood cells, prothrombin time, activated partial prothrombin time, fibrinogen, hemorrheol ogy,lactic acid, interleukin 6 and tumor necrosis factor and so on. SPSS20.0 application software, the data obtained using anal- ysis of variance and t test. Results Hemoglobin： T, and T2-5 and postoperative paragraphs than, P〈 0.0005. HCT： T1 and T2-5ratio and T2 and T3-5, P〈0.0005. White blood cells： T1 and T2-3 comparison, T2 and T3 -5, T3 and T4 - 5, P〈0.0005. T1 with T5 than, P〈0.05. T4 and T5. P〈0.005. Platelet： T1 and T2-5 comparison, comparison of T2 and T3, T3 and T4-5, P〈 0.0005. Heart rate： T, and T2,P〈0.05; T1 and T2 and T3-5 compared with T3, P〈0.0005; Compare T2 and T4, P〈0.005. T2 compared with T5, T3 and T4-5, P〈0.01. Central venous pressure： T1 and T2-5, P〈 0.0005. Compare T2 and T3-5, P〈0.005. Mean arterial pressure： T1 and T4-5, T2 and T3 - 5, T3 and T4-5, P〈0.0005. Prothrombin time： T1 and T2-5, T2and T4, T3 and T4. P〈0.0005; T4 and Ts. P〈0.005. Activated partial prothrombin time： 1T and T2-4, T2 and T4-5. T3 and T4-5, P〈0.0005, T4 and T5,P〈0.05. Fibrinogen： T1 and T2-3, T2 and T4 - 5. T3 and T4-5, P〈0.0005. T2 and T3, P〈0.05. Whole blood viscosity （low shear） before and after operation, P〈0.0005. Lactic acid

关 键 词：骨盆骨折/治疗 外科手术 自体血回输 血流变学 凝血功能 乳酸 炎性因子 

分 类 号：R683.8[医药卫生—骨科学] R457[医药卫生—外科学]