兔常温体外循环中大剂量乌司他丁对凝血及纤溶系统影响.docVIP

兔常温体外循环中大剂量乌司他丁对凝血及纤溶系统影响 　 作者：昌克勤，杨大烜，王古岩，薛庆华，李立环 【摘要】 目的 观察兔常温体外循环（extracorporeal circulation,ECC）前应用大剂量乌司他丁对凝血和纤溶系统的影响。 方法 20只大耳白兔随机分成2 组：乌司他丁组（U组，n=10 ）和对照组（C组，n=10）。建立兔常温ECC模型，U组在ECC前给予乌司他丁10×104 U /kg，C组给予等量生理盐水。ECC转机30 min，流量为180～300 ml/min，肛温维持在36.5℃～37.5℃。分别记录ECC前、停机、停机后1 h、2 h和3 h的血流动力学指标，测定活化部分凝血激酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）和D二聚体（D-D）。结果 两组 PT ECC后均较ECC前显著延长（Plt;0.05），两组间PT在停机后3 h时有统计学差别，C组长于U组（Plt;0.05）。两组APTT ECC后也均较ECC前显著延长（Plt;0.01），同时间点U组APTT较C组延长更为明显（Plt;0.05）。两组血浆FIB含量ECC后均较ECC前显著降低（Plt;0.01），同时间点C组较U组下降更明显（Plt;0.05）。ECC后两组血浆D-D浓度较ECC前显著升高（Plt;0.05），同时间点C组D-D浓度升高较U组更为显著（Plt;0.05）。 结论 ECC后凝血因子消耗使APTT和PT延长，纤溶亢进使血浆FIB含量下降，DD浓度升高。ECC前应用大剂量乌司他丁可减少ECC中凝血因子的消耗，抑制纤溶系统的过度激活，改善ECC术后凝血功能。提示ECC前应用大剂量乌司他丁具有血液保护功能。 【关键词】 乌司他丁；体外循环；凝血功能；纤溶系统 Abstract: OBJECTIVE To investigate the effect of large dose of ulinastatin on coagulation- fibrinolysis system after extracorporeal circulation（ECC） by establishing the rabbit model of normothermia ECC. METHODS Twenty rabbits were randomly assigned to control group (Group C，n=10) and experiment group (Group U, n=10). The rabbits in Group U were administered ulinastatin 10×104 U /kg before ECC, while in Group C were received same volume of saline at the same time. All rabbits were undergoing ECC for 30 min at perfusion flow of 180-300 ml/min, with rectal temperature maintained from 36.5℃ to 37.5℃. Hemodynamic parameters were recorded before ECC, at termination of ECC, 1 hour, 2 hour and 3 hour after ECC. APTT, PT, FIB and D-dimer were determined at the above time point respectively. RESULTS APTTs were prolonged after ECC in both Group U and C（Plt;0.05）, but APTTs after ECC in Group U were significantly longer than those in Group C respectively（Plt;0.05）. PTs were prolonged after ECC in both Group U and C（Plt;0.05）. There was significant difference in PTs between Group U and Group C at 4 h after ECC. The latter was significantly longer than the former（Plt;0.05）. All levels of FIB in both Group U and C were decreased after