体外不同程度生理盐水稀释血液对凝血功能的影响

Effects of dilution of blood with different amount of physiological saline in vitro on blood coagulability

目的探讨用生理盐水在体外不同程度地稀释血液对凝血功能的影响。方法将19名成年健康志愿者的静脉血在体外用生理盐水稀释成体积比20%(生理盐水∶血液=2∶8),30%(生理盐水∶血液=3∶7),40%(生理盐水∶血液=4∶6),50%(生理盐水∶血液=5∶5),60%(生理盐水∶血液=6∶4)等5个梯度,并用未经稀释的全血作为对照。用Sonoclot凝血及血小板功能分析仪进行凝血功能检测,测量的数据包括激活的凝血时间(ACT)、凝结速率(CR)、达峰时间(TP)、最大凝血标记值(MCS)、血小板功能(PF)等。结果与对照组比较,20%稀释后ACT显著缩短(P<0.05),60%稀释后ACT显著延长(P<0.05),其余稀释度差异无统计学意义(P>0.05)。20%稀释后CR显著升高(P<0.05),50%、60%稀释后CR显著降低(P<0.05),其余稀释度差异无统计学意义(P>0.05)。20%稀释后TP显著缩短(P<0.05),其余各稀释度差异无统计学意义(P>0.05)。60%稀释后MCS显著降低(P<0.05),其余各稀释度差异无统计学意义(P>0.05)。20%稀释后PF显著升高(P<0.05),其余稀释度差异无统计学意义(P>0.05)。结论血液稀释后凝血功能与血液稀释程度相关,生理盐水占20%加快了血液凝固的进程,30%、40%稀释的凝血功能未受影响,50%稀释的血液凝固能力开始减弱,60%稀释的血液凝固能力受到严重影响。

Objective To investigate the effects of dilution of whole blood in vitro with different amount of normal saline on blood coagulation. Methods Nineteen healthy adult volunteers were enrolled in the present study. Venous blood samples obtained from each volunteer were diluted with normal saline in saline/blood ratio （v/v） of 2：8 （20%）, 3：7 （30%）, 4：6 （40%）, 5：5 （50%） and 6：4 （60%）. Undiluted blood was considered as control. Coagulability of each group was determined with Sonoclot coagulation and platelet function analyzer, including activated clotting time （ACT）, clot rate （CR）, time to peak （TP）, maximal clot signal （MCS）, and platelet function （PF）. Resuits 1） ACT： Compared with control value, ACT was significantly shortened with 20% dilution （P〈0. 05）, and was significantly prolonged with 60% dilution （P〈0.05）, but no significant difference was observed in other dilutions. 2） CR： Compared with control value, CR was greatly increased at 20% dilution （P〈0.05）, and was reduced significantly at 50% and 60% dilutions （P〈0. 05）, whereas it was nearly unaffected in other dilutions. 3） TP： 20% hemodilution with normal saline shortened TP significantly compared with control value （P〈0. 05）, whereas no obvious changes were found in other dilution groups; 4） MCS： 60% hemodilution reduced MCS signifieantly compared with control value （P〈0. 05）, whereas no significant changes were found in other dilution groups. 5） PF： 20% bemodilution elevated PF significantly compared with control value （ Ix〈20. 05）, whereas no significant changes were found in other dilutions. Conclusions Changes in blood coagulation are closely related to the degree of hemodilution. Hemodilution （up to 20%） with saline may promote coagulation, whereas coagulation is not affected by increased hemodilution （up to 30% and 40%） with saline. However, hemodilution （up to 50%） with saline begins to impair the coagulation function, and at 60% hemodilution, coagulation will be seriously impaired.