复苏性主动脉球囊阻断术对肝损伤伴失血性休克后凝血功能的影响  

Effect of resuscitative endovascular balloon occlusion of the aorta on coagulation functions in a porcineliverinjury with hemorrhagic shock

作　　者：赵阳 李程程 高建新 宋国庚 单毅[3] ZHAO Yang;LI Chengcheng;GAO Jianxin;SONG Guogeng;SHAN Yi(School of Medicine,South China University of Technology,Guangzhou 510006,Guangdong,China;Department of Emergency Medicine,The First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Emergency Medicine,The Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]华南理工大学医学院,广州510006 [2]解放军总医院第一医学中心急诊科,北京100853 [3]解放军总医院第六医学中心急诊科,北京100048

出　　处：《医学研究与战创伤救治》2023年第2期120-125,共6页Journal of Medical Research & Combat Trauma Care

基　　金：国防科技创新特区项目(19-163-15-ZD-009-001-07)。

摘　　要：目的长时间的复苏性主动脉球囊阻断术(REBOA)可引起缺血再灌损伤,但其对创伤后凝血功能的影响尚不明确。文中旨在探讨60 min的REBOA对创伤性凝血病(TIC)发生的影响。方法选取10头健康成年普通级、长白猪,使用实验用弹道枪构建肝穿透伤合并失血性休克模型,随机分为实验组(在主动脉1区行REBOA并阻断60 min)和对照组(在主动脉1区行REBOA但未阻断血流),每组5头。连续监测基本生命体征及血流动力学参数,并在基线点、休克点及休克后每60 min的观察点采集血样本,进行动脉血气,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)等常规凝血指标和血栓弹力图(TEG)检测。结果60 min观察点,实验组的SBP、DBP、MAP、CO、Lac、Hb明显高于对照组(P<0.05),pH、Fib和R值明显小于对照组(P<0.05)。Log-Rank检验结果显示,实验组的生存率显著高于对照组(P=0.002)。对照组休克点的PT和INR较基线点明显增加(P<0.05),Angle较基线点明显降低(P<0.05),R值较基线点、60 min观察点明显增加(P<0.05)。实验组休克点的PT和INR、R值较基线点明显增加(P<0.05),120 min及180 min的观察点PT和INR较休克点明显增加(P<0.05),60 min及180 min观察点的R值较休克点明显增加(P<0.05),血清钙离子浓度在120 min及180 min观察点明显小于休克点(P<0.05),Fib在180 min的观察点较休克点明显减少(P<0.05)。结论REBOA能有效控制肝穿透伤出血,改善并维持近端血压,提高创伤后存活率。但主动脉1区60 min的REBOA加重了酸中毒,诱发了TIC的低凝状态并导致钙离子浓度和纤维蛋白原水平降低,需谨慎实施并严密监测处理。Objective Prolonged resuscitative endovascular balloon occlusion of the aorta(REBOA)can induce ischemia-reperfusion injury,but its effect on posttraumatic coagulation is unclear.This article will explore the effect of 60-min REBOA on the occurrence of trauma-induced coagulopathy(TIC).Methods Ten healthy,adult,ordinary grade Landrace swine were used in this study.Experimental ballistic gun was used to project a model of swine liver injury and hemorrhagic shock,then randomization to the control group(60-min Zone 1 REBOA)and the experimental group(Zone 1 REBOA without occlusion),5 heads per group.Continuous recording of vital signs and hemodynamic parameters was performed.Blood samples were obtained at baseline,shock point and every 60min after shock for blood gas analysis,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib)and thromboelastographic coagulation analyzer(TEG).Results At 60 min,the SBP,DBP,MAP,CO,Lac,and Hb in the experimental group were significantly higher than the control group(P<0.05),and the pH,Fib and R values were significantly lower than the control group(P<0.05).The Log-Rank test showed that the survival rate of the experimental group was significantly higher than that of the control group(P=0.002).In the control group,the PT and INR at the shock point were significantly higher than the baseline(P<0.05),the Angle was significantly lower than the baseline(P<0.05),and the R value was significantly higher than the baseline and the 60min observation point(P<0.05).In the experimental group,the values of PT,INR and R at the shock point were significantly higher than those at the baseline(P<0.05),the PT and INR at the 120 and 180 min were significantly higher than those at the shock point(P<0.05),and the R value at 60 and 180 min was significantly increased compared with the shock point(P<0.05).The level of serum calcium at 120 and 180 min was significantly lower than the shock point(P<0.05),and the Fib at 180 min was significantly lower than the shock point(P<0.05).Conclu

关 键 词：复苏性主动脉球囊阻断术 肝穿透伤 失血性休克 创伤性凝血病 

分 类 号：R575[医药卫生—消化系统]