不同复苏液对失血性休克大鼠外源性凝血系统凝血因子的影响

Influence on blood coagulation factors of extrinsic coagulation system in rats with hemorrhagic shock by resuscitation with various fluids

目的探讨不同复苏液对失血性休克大鼠外源性凝血系统凝血因子的影响及意义。方法 50只Sprague daw ley(SD)大鼠随机分为5组(对照组、假手术组、休克组、林格组和万汶组),每组10只。建立失血性休克大鼠模型后,复苏各组在失血性休克1 h后给予不同复苏液(林格氏液、6%万汶+林格氏液),复苏2h后采血。采用一期凝固法测定凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅹ活性(FⅡ:C、FⅤ:C、FⅦ:C、FⅩ:C)及血浆凝血酶原时间(PT)和活化部分凝血活酶时间(APTT),C lauss法测定纤维蛋白原(FIB)含量,并将各组的变化进行比较分析。结果对照组与假手术组比较各指标,差异无统计学意义(P>0.05)。与假手术组比较,休克组、林格组和万汶组FⅡ:C、FⅦ:C、FⅩ:C和FIB含量均明显下降,PT、APTT明显延长,差异有统计学意义(P<0.01)。与休克组比较,林格组FⅡ:C、FⅦ:C、FⅩ:C明显下降,PT、APTT明显延长;万汶组FⅡ:C、FⅦ:C、FⅩ:C明显升高,PT、APTT明显缩短,差异有统计学意义(P<0.01或P<0.05)。FⅤ:C休克组明显高于假手术组,万汶组明显低于假手术组和林格组,差异有统计学意义(P<0.01)。结论大鼠失血性休克外源性凝血系统凝血因子除FⅤ:C外均出现不同程度的降低;单用林格液复苏可出现缺血再灌注损伤,使凝血功能更加紊乱;采用万汶+林格液复苏对凝血功能有改善作用。

Objective To investigate the influence and clinical value on blood coagulation factors of extrinsic coagulation system in rats with hemorrhagic shock by resuscitation with various fluids.Methods 50 Sprague dawley（SD） rats were randomly classified into 5 groups including control group,sham operation group,shock group,Ringer′s lactate group and VOLUVEN group（10 rats per group）.The rats in Ringer′s lactate group and VOLUVEN group had been subjected to hemorrhagic shock for 1 h,and followed by resuscitation with Ringer′s lactate and 6% VOLUVEN＋lactate.After resuscitation for 2 h,blood coagulation factor Ⅱ,Ⅴ,Ⅶ,Ⅹ activities（FⅡ：C,FⅤ：C,FⅦ：C,FⅩ：C）,plasma prothrombin time（PT） and activated partial thromboplastin time（APTT） were determined by one-stage coagulation method,and fibrinogen（FIB） was determined by Clauss method.All the parameters were analyzed compara-tively among the 5 groups.Results There was no statistical significance between the control group and sham operation group in all parameters（P0.05）.Compared with sham operation group,the levels of FⅡ：C,FⅦ：C,FⅩ：C and FIB in shock group,Ringer′s lactate group and VOLUVEN group were all obviously decreased,while the levels of PT and APTT were obviously extended（P0.01）.Compared with shock group,the levels of FⅡ：C,FⅦ：C,FⅩ：C in Ringer′s lactate group were all obviously decreased,while the levels of PT and APTT were obviously extended（P0.01 or P0.05）.The levels of FⅡ：C,FⅦ：C,FⅩ：C in VOLUVEN group were increased,but the levels of PT and APTT were shortened（P0.01or P0.05）.The levels of FⅤ：C in shock group were higher than those in sham operation group,while those in VOLUVEN group were lower than those in sham operation group and Ringer′s lactate group（P0.01）.Conclusions Except FⅤ：C,the other blood coagulation factors of extrinsic coagulation system in rats with hemorrhagic shock are decreased.By resuscitation with Ringer′s lactate only,ischemic reperfusion injury and blood coagulation function disorder will appear in rats.However,by resuscitation with VOLUVEN and Ringer′s lactate together,blood coagulation function in rats with hemorrhagic shock can be improved.