【摘要】 目的对内毒素诱导急性肺损伤(ALI)幼猪行连续性血液透析滤过治疗,观察其对凝血功能的影响。方法18头小白猪随机分为对照组、肝素组和治疗组,每组各6头。予内毒素150μg/kg静脉注射诱导肺损伤。成模后治疗组行连续性血液透析滤过6 h,血流速度50 ml/min,透析液速度600 ml/h,置换液速度300 ml/h,肝素持续泵入保持活化凝血时间(ACT)180～250 s。成模后肝素组予肝素静脉维持保持ACT 180～250 s。于动物基础状态(B)、成模(A0h)、成模后2 h(A2h)、4 h(A4h)、6 h(A6h)分别采静脉血行外周血细胞计数、凝血酶原时间(PT)、白陶土部分凝血活酶时间(APTT)、纤维蛋白原(FiB)、D-二聚体(D-D),采动脉血行血气分析。记录心率(HR)、呼吸(RR)、血压(MABP)、肺动态顺应性(Cdyn)。结果各组动物A0h改良氧合指数(P/F)、Cdyn、MABP较B下降,HR、RR较B上升,PT和APTT延长,FiB下降,D-D增加,组间比较差异无统计学意义;A6h治疗组动物P/F、Cdyn、HR、MABP与对照组和肝素组比较差异有统计学意义。实验中PT、APTT进行性延长,组间比较PT差异无统计学意义,治疗组A2h、A4h、A6h APTT与对照组比较差异有统计学意义,肝素组A6h APTT与对照组比较差异有统计学意义。A6h治疗组和肝素组纤维蛋白原较对照组有明显改善。治疗组A2h、A4h、A6h D-D均较对照组改善,肝素组A4 h、A6h D-D较对照组改善,差异有统计学意义(P<0.05)。结论连续性血液透析滤过可改善肺损伤动物的氧合、呼吸力学,对动物的凝血状态无不利影响。更多还原

【Abstract】 Objectives To investigate the effect of continuous veno-venous hemodiafiltration(CVVHDF)on coagulation function of endotoxin-induced acute lung injury(ALI)of the piglets.Methods Eighteen piglets were randomly divided into three groups:control group(n = 6),heparin group(n = 6),and treatment group(n = 6).All the animals were received intravenous infusion of 150 μg/kg endotoxin to induce acute lung injury.When the oxygenation index < 300 and pulmonary compliance < 30% of the baseline,the animals of treatment group received CVVHDF with the blood rate of 50 ml/min,replacement rate of 300 ml/h,and dialysis rate of 600 ml/h for six hours and heparin infusion to keep blood ACT 180 ～ 250 s,the anmials of heparin group received heparin infusion only to maintain blood ACT 180 ～ 250 s.The coagulation paramenters:PT,APTT,FiB,D-D were measured and recorded at baseline,onset of ALI,two hours,four hours,six hours after ALI.At the same time,heart rate(HR),mean aterial blood pressure(MABP),respiratory rate(RR),pulmonary compliance(Cdyn),oxygenation index(P/F)were also recorded.Results No significant difference of all the parameters were found at baseline and onset of ALI among three groups.When the ALI occurred,P/F,Cdyn,ABP,and FiB of three groups’animals decreased;HR,RR,PT,APTT,D-D increased.After two hours,four hours,and six hours of ALI,D-D of treatment group improved compared with control group(P < 0.05=.After four hours and six hours of ALI,D-D of heparin group improved compared with control group(P < 0.05=.After six hours,the FiB of treatment group and heparin group improved compared with control group(P < 0.05=.Differene were not found between treatment group and heparin group.After six hours,the HR,ABP,P/F,Cdys were also improved of treatment group compared with control group and heparin group(P < 0.05=.Conclusions CVVHDF has good effect on cardic and pulmonary function and has no harmful effect on coagulation of the endotoxin-induced acute lung injury of the piglets.更多还原