兔心肺复苏基本生命支持阶段凝血-纤溶改变及药物的干预作用

Change of blood coagulatinn-fibrinolysls system and pharmaceutical effect during basic life support of cardiopulmonary resuscitation in the rabbits

目的观察家兔心脏骤停（CA）后心肺复苏（CPR）的基本生命支持（BLS）阶段中凝血-纤溶改变以及抗凝溶栓药物的干预作用。方法24只家兔随机分为实验组和对照组，在交流电诱发CA后对照组只进行BLS，实验组在此基础上给予尿激酶和肝素进行干预，分别于诱发CA前（0rain）、CA后5、10、15、20、25、30min时采血测定凝血酶原时间（Pr）、国际标准化比值（INR）、部分凝血活酶活化时间（APTT）、纤维蛋白原（Fib）、凝血酶时间（TT）、纤溶酶原激活物（t-PA）及纤溶酶原激活抑制物．1（PAI-1）和D-二聚体（DD）。以全部实验动物诱发CA前所测值为样本估计总体均数的95％置信区间并看作各个观察指标的参考值范围；两组完全随机化设计的计量资料的比较采用t检验；计量资料同组内不同时点之间资料的比较采用配伍资料的方差分析。结果对照组内动脉血PT、INR、APTT的值在CA后CPR的BLS阶段随时间延长而下降（P〈0．05），TT值、Fib和DD质量浓度变化不明显（P〉0．05），t-PA质量浓度随时问延长不断下降（P〈0．05），PAI-1质量浓度随时间延长而升高（P〈0．05）。实验组经抗凝、溶栓药物干预后，PT、INR、APTT和TT的值出现明显升高（P〈0．05），Fib质量浓度随时间延长逐渐下降（P〈0．05），DD、t-PA和PAI-1质量浓度无明显变化（P〉0．05）。实验组PT、INR、APTT、TT、t—PA和PAI-1的变化趋势与对照组明显不同（P〈0．05），DD的变化两组相似（P〉0．05）。结论在CA后的BLS阶段出现凝血-纤溶系统功能的动态改变：凝血活性增强，而纤溶活性降低。给予溶栓、抗凝药物的干预可以使血液的抗凝作用和纤溶活性增强，有可能逆转凝血-纤溶功能的失衡或保持凝血-纤溶间的动态平衡。

Objective To study change of blood coagulation-fibrinolysis system and pharmaceutical effect during basic life support （BLS） of cardiopolmonary resuscitation （CPR） after cardiac arrest （CA） in the rabbits. Method Twenty-four rabbits were randomly divided into control and experiment group. After CA induced by alternating current, both groups were given with BLS, and the experiment group was also given with heparin and urokinase by intravenous injection. The blood was collected for detecting prothrombin time （PT）, international normalized ratio （INR）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, thrombin time （TT）, D- dimer （DD）, tissue-type plasminogen activator （t-PA） and plasminogen activator inhibitor-1 （PAI-1） per 5 minutes before and after CA respectively. The data were analyzed by using Chi-square test and Student＇ s t test with SPSS 13.0. A P value less than 0.05 indicated statistical significance. Results In BLS phase of CPR after CA, the PT, INR, APTT, and t-PA in control group were significantly decreased with time （P 〈0.05）, the TT, the concentration of Fib and DD didn＇ t change significantly （ P 〉 0.05）, while the concentration of PAI-1 significantly increased with time （ P 〈 0.05）. After treated with anticoagulant and thrombolytic drugs, the PT,INR, APTT, and TT in the experiment group were significantly increased with time （ P 〈 0.05）, the concentration of Fib decreased significantly （ P 〈 0.05）, while the DD, the concentration of PAI-1 didn＇ t change significantly （P〉 0.05）. The change of FF, INR, APTT, TT, t-PA and PAI-1 in the experiment group is significantly different from those in the control group （ P 〈 0.05）, while the change of DD is similar in the two groups （ P 〉 0.05）. Conclusions Duriong the BLS phase of CPR after CA, dynamic change of blood coagulation and fibrinolysis systems appears, that＇ s the anticoagulation function increases and the fibrinolysis activation decreases. The treaTment of anticoagulation and thrombolysis can probably reverse the unbalance of coagulation and fibrinolysis or keep the dynamic balance between the coagulation and fibrinolysis systems.