不同液体复苏对失血性休克猪凝血功能影响

Effects of different fluid resuscitation on coagulation function in hemorrhagic shock pigs

目的探讨不同液体复苏对失血性休克(HS)猪凝血功能的影响。方法将18头雄性清洁级巴马小型猪随机分为HS组、醋酸林格(AR)组、自体全血复苏(BR)组,每组各6头。AR组和BR组经股动脉放血建立失血性休克模型,维持60 min后分别输注AR液和自体全血;HS组建立模型后不复苏。于放血前(T0)、休克后1 h(T1)、复苏后1 h(T2)及复苏后6 h(T3)监测各时间点3组实验猪的肺动脉温度(Tp),并分别行动脉血气分析、血栓弹力图(TEG)检测。结果T0~T2时,3组实验猪的Tp值比较,差异均无统计学意义(P>0.05)。T3时,HS组仅存活1头。BR组T3时的Tp值高于AR组,两组间比较,差异有统计学意义(P<0.05)。T1时,3组实验猪动脉血乳酸(Lac)升高,复苏后有所降低;T2、T3时,BR组Lac均低于AR组,两组间比较,差异均有统计学意义(P<0.05)。T1时,3组实验猪的红细胞压积(Hct)和血小板计数(Plt)均降低;T2时,AR组Hct、Plt均低于HS组,BR组Hct、Plt均高于HS组,AR组Hct、Plt均低于BR组,差异均有统计学意义(P<0.05);T3时,AR组Hct、Plt均低于BR组,差异均有统计学意义(P<0.05)。T0、T1时,3组实验猪的凝血时间(R值)、血块形成时间(K值)、血块形成速率(α角)、最大切应力系数(MA值)、凝血综合指数(CI值)、MA值确定后30 min内血凝块消融(或减少)的速率(LY30)及预测在MA值确定后30 min内血凝块将要溶解的百分比(EPL)水平比较,差异均无统计学意义(P>0.05);T2时,AR组实验猪的R值大于HS组,BR组实验猪的R组小于HS组,差异有统计学意义(P<0.05);T3时,BR组实验猪的R值大于AR组,差异有统计学意义(P<0.05)。T2时,HS组实验猪的K值大于AR组和BR组,AR组K值大于BR组,差异有统计学意义(P<0.05);T3时,BR组实验猪的K值大于AR组,差异有统计学意义(P<0.05)。T2时,3组实验猪的α角均减小,且AR组实验猪的α角小于HS组,BR组大于HS组,差异均有统计学意义(P<0.05);T3时,AR组和BR组的α角均增大,且AR组大于BR组,差异均有统计学意义(P<0.05)。T2时,AR组和BR组实验猪的MA值均高于HS组,且BR组的MA值高于AR组,差异均有统计学意义(P<0.05);T3时,BR组实验猪的MA值高于AR组,差异有统计学意义(P<0.05)。T2时,BR组的CI值高于HS组和AR组,AR组高于HS组,差异均有统计学意义(P<0.05);T3时,AR组的CI值高于BR组,差异有统计学意义(P<0.05)。T2时,HS组的LY30、EPL水平明显高于AR组和BR组,AR组明显高于BR组,差异均有统计学意义(P<0.05);T3时,AR组的LY30、EPL水平明显高于BR组,差异均有统计学意义(P<0.05)。结论AR液和自体BR均可改善HS猪TEG的各指标水平,在一定程度上纠正HS猪的凝血功能障碍,且自体全血的复苏效果更佳。

Objective To investigate the effect of different fluid resuscitation on coagulation function of hemorrhagic shock(HS)pigs.Methods The clean grade Bama minipigs were randomly divided into the HS group,acetate ringer(AR)group and autologous blood resuscitation(BR)group,with 6 pigs in each group.The model of HS was established in AR group and BR group by bleeding from femoral artery.After 60 minutes,AR and autologous BR were infused,respectively,and no resuscitation was observed in HS group.Pulmonary artery temperature(Tp)of the 3 groups of pigs was monitored at each time point before bleeding(T0),1 hour(T1)after shock,1 hour(T2)and 6 hours(T3)after resuscitation,and arterial blood gas analysis and thrombelastogram(TEG)were performed,respectively.Results At T0 to T2,there was no statistically significant difference in Tp values between the three groups(P>0.05).At T3,only one pig survived in HS group.Tp value in BR group at T3 was higher than that in AR group(P<0.05).At T1,lactic acid(Lac)in three groups increased,and decreased after resuscitation.At T2 and T3,Lac in BR group was lower than that in AR group(P<0.05).At T1,the hematocrit(Hct)and platelet(Plt)values of the three groups of pigs reduced.At T2,Hct and Plt of the AR group were lower than those of the HS group,Hct and Plt of the BR group were higher than those of the HS group,and Hct and Plt of the AR group were lower than those of the BR group(P<0.05).At T3,Hct and Plt in AR group were lower than those in BR group(P<0.05).At T0 and T1,there were no statistically significant differences in R value,K value,αangle,MA value,CI value,LY30 and EPL level among the three groups(P>0.05).At T2,R value of AR group was greater than that of HS group,while R value of BR group was smaller than that of HS group(P<0.05).At T3,R value of experimental pigs in the BR group was greater than that in the AR group(P<0.05).At T2,the K value of HS group was greater than that of AR group and BR group,and K value of AR group was greater than that of BR group(P<0.05).At T3,the K value of experimental pigs in the BR group was greater than that in the AR group(P<0.05).At T2,theαangle of the three groups of pigs reduced,and theαangle of the AR group was smaller than that of the HS group,whileαangle of the BR group was larger than that of the HS group(P<0.05).At T3,αangle of AR group and BR group increased,and AR group was larger than BR group(P<0.05).At T2,MA values of AR group and BR group were higher than those of HS group,and MA values of BR group were higher than those of AR group(P<0.05).At T3,the MA value of experimental pigs in BR group was higher than that in AR group(P<0.05).At T2,the CI value of BR group was higher than that of HS group and AR group,and CI value of AR group was higher than that of HS group(P<0.05).At T3,the CI value of AR group was higher than that of BR group(P<0.05).At T2,LY30 and EPL levels in HS group were significantly higher than those in AR group and BR group,while those in AR group were significantly higher than those in BR group(P<0.05).At T3,LY30 and EPL levels in AR group were significantly higher than those in BR group(P<0.05).Conclusion Both AR solution and autologous BR can improve the TEG index level of HS pigs,and correct the coagulation dysfunction of HS pigs to some extent,and the resuscitative effect of autologous blood resuscitation is better.