新型冻干血小板联用乳酸林格氏液救治家兔失血性休克海水浸泡的复苏效果观察  

Resuscitation effect of novel lyophilized platelets combined with lactated Ringer’s solution in rabbits with hemorrhagic shock and seawater immersion

作　　者：代承麟 杜文琼 唐婷 杨昊洋 陈丽缘 张冬朝阳 钟鑫 蒋仁庆 陈灿 贾益君 宗兆文 胡波[3] DAI Chenglin;DU Wenqiong;TANG Ting;YANG Haoyang;CHEN Liyuan;ZHANG Dongzhaoyang;ZHONG Xin;JIANG Renqing;CHEN Can;JIA Yijun;ZONG Zhaowen;HU Bo(State Key Laboratory of Trauma and Chemical Poisoning,Department of Combat Casualty Care,Training Base for Health Care,Army Medical University(Third Military Medical University),Chongqing;Department of Combat Casualty Care and Health Care,Noncommissioned Officer School,Army Medical University(Third Military Medical University),Shijiazhuang,Hebei,China;Experimental Center of Basic Medicine,College of Basic Medical Sciences,Army Medical University(Third Military Medical University),Chongqing)

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,创伤与化学中毒全国重点实验室,重庆 [2]陆军军医大学(第三军医大学)士官学校战救医疗系,河北石家庄 [3]陆军军医大学(第三军医大学)基础医学院基础医学教学实验中心,重庆

出　　处：《陆军军医大学学报》2025年第8期756-765,共10页Journal of Army Medical University

基　　金：创伤与化学中毒全国重点实验室Ⅰ类课题(SKLTS202213)。

摘　　要：目的评估新型冻干血小板(lyophilized platelet,LP)即凝血酶刺激下LP联用乳酸林格氏液对家兔失血性休克海水浸泡的复苏效果。方法将50只家兔按随机数字表法分为A、B、C、D、E 5组(n=10),3%戊巴比妥钠按1 mL/kg剂量麻醉家兔,给予左下肢软组织损伤,同时以纱布止血,计量下肢软组织损伤的失血量。右下肢进行股动脉插管,随后按照家兔总血容量的26%进行抽血,后将家兔竖直浸泡在3%人工海盐模拟海水中,海水没过剑突,15 min后捞出。按照A组:致伤后不复苏;B组:致伤后输注乳酸林格氏液;C组:致伤后输注乳酸林格氏液及新鲜血小板;D组:致伤后输注乳酸林格氏液加LP;E组:致伤后输注乳酸林格氏液加新型LP,给予对应复苏策略。实验在致伤前及伤后1、2、4 h检测凝血功能、血常规、血气、血栓弹力图等指标。结果成功制备出具有功能活性的LP及家兔失血性休克海水浸泡损伤模型。在致伤后1 h,联用血小板制剂复苏的C、D、E组平均动脉压(mean arterial pressure,MAP)显著高于未复苏的A组(P<0.05),C组的乳酸值(lactate,Lac)显著低于A、B组(P<0.05),C、D、E组的碱剩余(base excess,BE)及尿素氮(blood urea nitrogen,BUN)显著低于A、B组(P<0.05),A组的凝血酶原时间(prothrombin time,PT)较致伤前显著延长(P<0.05)。伤后2 h,C、D组的MAP高于A、B组,E组MAP高于A组(P<0.05),C、E组的Lac低于A、B组,而D组Lac低于A组(P<0.05),C、D、E3组的BE、BUN值均低于A、B组(P<0.05),C组的最大振幅(maximum amplitude,MA)高于A组,A、D组此刻MA值较本组致伤前显著下降(P<0.05),A、D组的活化部分凝血时间(activated partial clotting time,APTT)较致伤前延长(P<0.05)。伤后4 h,C、D、E组的MAP高于A、B组,B组MAP高于A组(P<0.05),C、D、E组的Lac、BUN值均低于A、B组(P<0.05),C、D组BE值低于A组,E组BE值低于A、B组(P<0.05),B、C、E组的MA值高于A组(P<0.05),而A、D组的MA值、APTT值较致伤前本组初始值显�Objective To evaluate the resuscitation efficacy of novel lyophilized platelets(LP,thrombin-stimulated platelets)combined with lactated Ringer’s(LR)solution in rabbits with hemorrhagic shock and seawater immersion.Methods Fifty rabbits were randomly assigned to 5 groups(Groups A,B,C,D and E,n=10).After all rabbits were anesthetized with 3%pentobarbital sodium at a dose of 1 mL/kg,soft tissue injury was inflicted in the left lower limb.The blood loss from the soft tissue injury was quantified after gauze hemostasis.The right lower limb was subjected to femoral artery catheterization,followed by blood withdrawal equivalent to 26%of the total blood volume of the rabbit.The rabbits were then vertically immersed in 3%artificial seawater,with the water level reaching above the xiphoid process,and were retrieved in 15 min later.Resuscitation strategies were applied to the rabbits from different group:Group A(no resuscitation),Group B(resuscitation with LR solution),Group C(resuscitation with LR solution and fresh platelets),Group D(resuscitation with LR solution and LP),and Group E(resuscitation with LR solution and novel LP).Coagulation function test,routine blood test,blood gas analysis,and thromboelastography were conducted at baseline and at 1,2 and 4 h after injury.Results The LP and rabbit model of hemorrhagic shock and seawater immersion were successfully prepared.At 1 h after injury,the mean arterial pressure(MAP)of Groups C,D and E(infused with platelet preparations)was significantly higher than that of Group A(without resuscitation,P<0.05);the lactate(Lac)content of Group C was obviously lower than that of Groups A and B(P<0.05);the base excess(BE)and blood urea nitrogen(BUN)levels of Groups C,D and E were notably lower than those of Groups A and B(P<0.05);and the prothrombin time(PT)of Group A was significantly longer than that of before injury(P<0.05).At 2 h after injury,the MAP of Groups C and D was significantly higher than that of Groups A and B,and that of Group E was notably higher than that of Group

关 键 词：冻干血小板 失血性休克 海水浸泡 复苏 血栓弹力图 

分 类 号：R605.971[医药卫生—急诊医学] R835.341[医药卫生—外科学] R977.8[医药卫生—临床医学]