摘要
目的研究连续血液滤过(CRRT)复温过程中采用局部枸橼酸抗凝或全身肝素抗凝对意外低体温症犬的影响。方法成年比格犬19只,制作腹部开放伤合并海水浸泡致重度低体温症(28±0.5℃)模型,按复温方式随机分为温水浴复温组(对照组,n=5)、CRRT复温全身肝素抗凝组(肝素抗凝组,n=7)和CRRT复温局部枸橼酸抗凝组(枸橼酸抗凝组,n=7)。复温过程中检测实验犬动脉血气、凝血功能、血清电解质、血生化以及心脏指数(CI)等指标,同时观察各组死亡率。结果复温过程中3组死亡率分别为:肝素抗凝组14.3%(1/7),枸橼酸抗凝组0(0/7),对照组40.0%(2/5)。复温过程中体温上升至38℃时,肝素抗凝组血小板(PLT)与其他两组比较明显下降(P<0.05),对照组HCO3–与其他两组比较明显下降(P<0.05)。体温上升至34℃和38℃时,对照组血肌酐与其他两组比较明显上升(P<0.05),肝素抗凝组活化部分凝血酶原时间(APTT)与其他两组比较明显延长(P<0.05)。体温上升至30℃、34℃和38℃时,枸橼酸抗凝组血清钙离子与其他两组比较明显升高(P<0.05)。各时间点3组之间血清钠离子浓度、p H值、凝血酶原时间(PT)、国际标准化比率(INR)、ALT、CI比较差异无统计学意义(P>0.05)。结论 CRRT加温水浴复温较单独温水浴复温对意外低体温症犬代谢性酸中毒改善效果更好,且CRRT复温中采用局部枸橼酸抗凝较全身肝素抗凝对意外低体温症犬的凝血系统、血小板影响更小。
Objective To obser ve the influences of regional citrate or systemic heparin anticoagulation on acid-base balance, coagulation, electrolytes, serum creatinine, alanine aminotransferase（ALT） and cardiac index（CI） during continuous renal replacement therapy（CRRT） rewarming in accidental hypothermia dogs. Methods Nineteen adult beagles were given abdominal trauma coupled with deep hypothermia [（28±0.5）℃] induced by seawater immersion for establishing animal model of trauma. According to rewarming ways, the animal models were randomly divided into three groups, comparison group（warm bath rewarming, n=5）, CRRT rewarming-systemic heparin anticoagulation group（heparin anticoagulation group, n=7） and CRRT rewarming-regional citrate anticoagulation group（citrate anticoagulation group, n=7）. During the rewarming routine blood examination was performed, and blood chemistry, coagulation function, blood gas and hemodynamic status were assayed, at the same time the mortality was recorded. Results During the rewarming, the mortality was 14.3%（1/7） in heparin anticoagulation group, 40.0%（2/5） in warm bath group and 0 in regional citrate anticoagulation group. Blood temperature increased to 38℃, the heparin anticoagulation group showed a significant decrease of platelet compared with citrate anticoagulation group and comparison group（P〈0.05）; The comparison group had a significant decrease of HCO3– compared with the other two groups（P〈0.05）. W hen the body temperature was increased to 34℃ and 38℃, the comparison group showed significant increase of serum creatinine compared with the other two groups（P〈0.05）; the heparin anticoagulation group presented significant prolongation of APTT compared with citrate anticoagulation group and comparison group（P〈0.05）. W hen the body temperature increased to 30℃, 34℃ and 38℃ respectively, the citrate anticoagulation group had significantly increased serum calcium compared with heparin anticoagulation group and comparison group（P〈0.05）. There was no difference in serum sodium, ALT and CI between the three groups at each time point（P〈0.05）. Conclusions CRRT plus warm bath rewarming have better effect on improving metabolic acidosis than warm bath rewarming alone in accidental hypothermia dogs. In comparison with systemic heparin anticoagulation, regional citrate anticoagulation has smaller influences on coagulation system and platelet when CRRT rewarming performed in accidental hypothermia dogs.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2016年第10期813-818,共6页
Medical Journal of Chinese People's Liberation Army
关键词
低体温
血液滤过
抗凝
hypothermia
hemofiltration
anticoagulation
