腹部开放伤合并海水浸泡时出凝血的变化

Change in coagulation after open abdominal wound subjected to seawater immersion

目的探讨实验犬腹部开放伤合并海水浸泡后高渗及低温对机体出凝血系统的影响。方法20只犬致腹部开放伤后被随机分为对照组（不经过海水浸泡）和海水浸泡组，每组10只。于致伤前（Oh）及致伤后1．5（打捞出水时）、4、8和12h检测两组内皮素-1（ET-1）、血小板α-颗粒膜蛋白140（GMP-140）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、D-二聚体、凝血因子Ⅱ等变化。结果海水浸泡后PT、APTT明显延长，D-二聚体、GMP-140、ET-1明显增加，凝血因子Ⅱ活性明显降低（P均〈0．05）。与对照组比较。海水浸泡组ET-1、PT、APTT、D-二聚体及凝血因子Ⅱ活性均有明显变化，差异有统计学意义（P均〈0．05），而GMP-140与对照组比较差异则无统计学意义（P均〉0．05）。结论腹部开放伤合并海水浸泡后可损伤血管内皮细胞，活化血小板，抑制凝血因子活性，引起凝血功能障碍、血栓形成和纤溶系统激活。

Objective To explore the effects of hyperosmotic fluid and low temperature on hemorrhage and coagulation system after immersion of dogs with open abdominal wounds in seawater. Methods Twenty healthy dogs were subjected to open abdominal injury, then dogs were randomized equally into two groups： the control group （n = 10） （without seawater immersion） and seawater immersion group （n= 10）. The variables of prothrombin time （PT）, partial thromboplastin time （APTT）, D-dimer and factor Ⅱ , granule membrane protein-140 （GMP-140）, endothelin-1 （ET-1） were determined. Results PT and APTT were significantly prolonged. D-direct, GMP-140, and ET-1 were increased, while factor Ⅱ was decreased after the dog with open abdominal wound was immersed in seawater （all P〈0. 05）. Compared with the variables of control group, PT, APTT, D-dimer and factor Ⅱ , ET-1 in seawater immersion group had markedly changed （all P〈0.05） except GMP-140 at different time points （all P〉0.05）. Conclusion Obvious vascular endothelial cell dysfunction, platelet activation, inhibition of coagulation factor activity, coagulopathy, and disorders in thrombosis and fibrolysis system activation occur after dogs with open abdominal wounds are immersed in seawater.