家兔软组织损伤合并失血性休克及海水浸泡后凝血-纤溶功能变化分析  

Changes of coagulation-fibrinolysis function after soft tissue injury complicated with shock and seawater immersion in rabbits

作　　者：杨昊洋 杜文琼 叶钊 钟鑫 陈灿 贾益君 蒋仁庆 秦昊[1] 张冬朝阳 宗兆文 YANG Haoyang;DU Wenqiong;YE Zhao;ZHONG Xin;CHEN Can;JIA Yijun;JIANG Renqing;QIN Hao;ZHANG Dongzhaoyang;ZONG Zhaowen(State key Laboratory of Trauma,Burn and Combined injuries,Department of Combat Casualty Care,Training Base for Health Care,Army Medical University(Third Military Medical University),Chongqing,400038;Second Brigade of Student,College of Basic Medical Sciences,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)陆军卫勤训练基地战救技能训练教研室,创伤、烧伤与复合伤国家重点实验室,重庆400038 [2]陆军军医大学(第三军医大学)基础医学院学员二大队,重庆400038

出　　处：《陆军军医大学学报》2023年第24期2579-2585,共7页Journal of Army Medical University

摘　　要：目的观察分析家兔软组织损伤合并休克及海水浸泡后凝血-纤溶功能变化。方法由陆军军医大学实验动物中心提供家兔20只,雌雄不限,年龄3~4个月,体质量(2.17±0.02)kg,按随机数字表法均分为A、B组。A组损伤家兔小腿和大腿肌群,损伤面积共约10 cm^(2),深度约1.5 cm,而后抽取家兔总血容量20%,即制成家兔软组织损伤合并失血性休克动物模型;B组动物在上述基础上,使用模拟海水浸泡40 min,浸泡深度为肋骨下缘水平。在伤前和伤后15 min、1 h、4 h和8 h,抽血检测血栓弹力图、常规凝血相、血小板计数和D-二聚体等,并观察各个时相点血压和存活率变化情况。结果致伤后两组家兔平均动脉压下降幅度达30%,成功建立家兔软组织损伤合并失血性休克模型,且两组休克无明显差异。B组8 h和24 h的存活率为70%和0,明显低于A组的90%和50%。B组凝血-纤溶功能变化比A组更为复杂和严重,表现在伤后8 h,活化部分凝血活酶时间明显延长[(29.53±4.36)vs(24.56±4.17)s]、反应时间R值延长[(3.07±0.69)vs(2.34±0.63)min]、D-二聚体浓度明显增高[(0.214±0.23)vs(0.037±0.03)mg/l]、血小板激活活性明显升高(508.67±86.69 vs 381.60±73.84),最大振幅值显著降低[(52.73±14.97)vs(63.52±3.86)mm]和血小板计数显著低于A组[(182.77±60.01)×10^(9)/L vs(236.78±52.14)×10^(9)/L。结论软组织损伤合并休克时,海水浸泡将导致凝血时间延长,而纤溶激活、血小板降低程度均明显高于无海水浸泡。ObjectiveTo observe and analyze the changes of coagulation and fibrinolytic function after soft tissue injured combined with shock and seawater immersion in rabbits.MethodsTwenty rabbits of either gender were provided by the Laboratory Animal Center of the Army Medical University,with a body weight of 2.17±0.02 kg,and were randomly divided into the group A and the group B(n=10).The calf and thigh muscle of rabbits in the group A were injured with a total area of about 10 cm^(2)and a depth of about 1.5 cm.Then 20%of the total blood volume of rabbits was extracted to make the animal model for injured soft tissue complicated with hemorrhagic shock.Animals in group B were immersed in simulated seawater for 40 min on the basis of the procedure in the group A mentioned before,and the depth of immersion was at the lower margin of ribs.Before and after 15 min and 1,4,and 8 h of getting injured,blood samples were taken to detect thromboelastography,routine coagulation phase,platelet count and D-dimer level,and the changes in blood pressure and survival rate were observed at each time point.ResultsThe mean arterial pressure of rabbits in the 2 groups was decreased by 30%after injury.The model of rabbits with injured soft tissue combined with hemorrhagic shock was established successfully,and there was no significant difference in shock between the 2 groups.The changes of coagulation and fibrinolytic function in the group B were more complex and serious than those in the group A,which were manifested at 8 h after getting injury.The activation time of partial thrombin was significantly increased(29.53±4.36 vs 24.56±4.1 s),the reaction time was significantly increased(3.07±0.69 vs 2.34±0.63 min),the D-dimer concentration was significantly increased(0.214±0.23 vs 0.037±0.03 mg/L),platelet activation activity was significantly increased(508.67±86.69 vs 381.60±73.84),and the maximum amplitude was significantly lower(52.73±14.97 vs 63.52±3.86 mm).The platelet count in the group B was significantly lower than that in th

关 键 词：软组织 海水浸泡 失血性休克 凝血-纤溶系统 血栓弹力图 

分 类 号：R605.971[医药卫生—急诊医学] R641[医药卫生—外科学] R835.3[医药卫生—临床医学]