血必净注射液对兔肢体缺血再灌注损伤的治疗作用研究

摘要

Transfusion is one of the most important therapies in trauma care. It has been widely advised to implement a massive transfusion protocol ( MTP } to guide transfusion. In this review,we discussed the purpose of MTP, including reducing the amount of blood products transfused, improving the efficiency of transfusion, early correction of traumatic coagulopathy and reducing transfusion-realated complications. Since no agreement has been reached on the criteria for starting and stopping MTP,these vary among different institutions. Initiation of MTP was mostly based on the subjective judgement of the doctors. Some scoring systems have; been proposed,but needing further research. MTP is a standard process to guide the treatment of massive bleeding and traumatic coagidopathy, which involves the timing, dose and aim of utilization of packed reel blood cell, fresh frozen plasma, platelets, cryopre-cipitate and recombinant VII factor ( rF VII a ),and thorough collaboration is required among different departments such as trauma surgery,emergency department,blood bank, clinical laboratory and anesthesiology. It has been confirmed that the; implementation of MTP could reduce the amount of blood products used, improve transfusion eificien-cy,reduce the severity of traumatic coagidopathy and the mortality of organ failure,improve the survival rate of major trauma and reduce the transfusion-related complications. There are still some unsolved problems of MTP,inelueling the eriteria for eliagnosis and management of massive transfusion,the heart proportion of blooel components, effect on these patients with massive blecling anel early elcath,which descrve further study.%目的 探讨血必净注射液对肢体缺血再灌注损伤(IR)的治疗作用与机制.方法 20只新西兰大耳兔,采用Crinnion等的肢体缺血再灌注损伤动物模型.动物随机分为实验组和对照组各10只,实验组于恢复血流后给予血必净注射液4ml/kg体重,对照组给予等容量生理盐水.再灌注前及再灌注后1、2、4、6h分别采取静脉血测定凝血功能(APTT、FIB、PT_INR、PT)、血浆生化(ALB、AST、LDH、CK)、丙二醛(MDA)、超氧化物歧化酶(SOD)含量;6h后活杀取股直肌样本,测定肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)含量、肌组织干湿比,并行组织病理切片观察.结果 实验组再灌注后1、4h APTT较对照组有明显延长(P<0.01);PT及4、6h时FIB含较灌注前有明显延长(P<0.05);实验组再灌注后1h ALB含量与再灌前无差异(P>0.05);1~4h的LDH含量及1、4h时CK含量显著低于对照组(P<0.05);再灌注后2h时MDA含量显著低于对照组(P<0.05);再灌注后1~4h SOD活性均显著高于对照组(P<0.05).实验组股直肌TNF-α、IL-6及干湿比与对照组差异无统计学意义(P>0.05).结论 血必净注射液有减轻肢体缺血再灌注损伤的作用,其机制与调节凝血功能、改善毛细血管通透性、抑制氧自由基的产生、减少脂质过氧化物(LPO)的形成等有关.