体外大剂量失血/输血模型的建立及不同大剂量输血策略对模型凝血功能的影响  

Coagulation functions in a large-dose blood loss/transfusion model by different protocols in vitro

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,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心输血医学科,北京100853

出　　处：《中国输血杂志》2021年第6期599-603,共5页Chinese Journal of Blood Transfusion

基　　金：军队医学科技青年培育项目(14QNP106)。

摘　　要：目的建立体外大剂量失血/输血模型,评价其凝血功能指标与血栓弹力图(TEG)拟合性,为临床大剂量输血救治患者提供理论依据。方法从2017年3月2日在解放军总医院第一医学中心输血医学科参加无偿献血的健康献血者中,选择8名采集静脉血,根据之前研究基础建立大量失血体外稀释模型,模拟大剂量输血策略输血和延迟补充血浆、血小板输血2种临床情况,建立输血模型M_(1)和M_(2),检测每个模型的血常规、常规凝血功能、凝血因子活性、TEG,统计并分析相关数据。结果 M_(1)与M_(2)比较,血小板计数(Plt)(×10^(9)/L):61.00±10.24 vs 28.83±10.36(P<0.01);TEG检测MA值(mm)为29.35±2.37 vs 20.53±2.76(P<0.01);各主要凝血因子活性约为40%vs 30%;TEG检测R值(min)为6.32±0.85 vs 7.27±0.63(相对基线值4.97±1.04);纤维蛋白原(Fib)(g/L)为1.10±0.08 vs 0.81±0.10(P<0.01),TEG检测Alpha角(°)25.65±4.95 vs 16.63±3.94。结论体外实验显示,采用及时补充输注血小板及冷沉淀等成分血的MTP,有效改善了体外大剂量失血/输血模型的Plt和Fib。Objective To evaluate common laboratory items in a large-dose blood loss model in vitro using thromboelastogram(TEG), to provide a reasonable infusion solution for clinical massive transfusions. Methods On March 2 nd, 2017, eight healthy blood donors who participated in voluntary blood donation in the Department of Blood Transfusion Medicine of the First Medical Center of the PLA General Hospital were selected to undergo phlebotomy, and an in vitro dilution model of massive blood loss was established based on the previous research,namely Model 1(M_(1), given massive transfusion protocol) and Model 2(M_(2), given packed red blood cells and plasma) were established. Then blood routine, routine coagulation function, clotting factor activity, TEG of each model were tested. Results The platelet count in the M_(1) model was 61.00±10.24(×109/L), and reduced to 28.83±10.36(×10^(9)/L) in M_(2) (P<0.01). The MA value(mm) of two groups detected by TEG was 29.35±2.37 vs 20.53± 2.76(P<0.01). In M_(1) and M_(2) model, The activities of primary clotting factors respectively decreased to about 40% and 30% to original in M_(1) and M_(2). The R value of TEG prolonged to(6.32±0.85) min and(7.27±0.63) min respectively, still within the normal range(baseline 4.97±1.04). The fibrinogen concentration in the M_(1) and M_(2) model decreased to(1.10±0.08) g/L and(0.81±0.10) g/L(P<0.01),which had the same variation tendency to Alpha angle of TEG(25.65±4.95 vs 16.63±3.94, P>0.05). Conclusion MTP with blood components supplemented such as platelet and cryoprecipitate in time has effectively improved the Plt and Fib in vitro large-dose blood loss/transfusion model.

关 键 词：大剂量输血 凝血功能 血栓弹力图 血小板 纤维蛋白原 

分 类 号：R457.1[医药卫生—治疗学] R619.1[医药卫生—临床医学]