肝素与枸橼酸抗凝在海水浸泡低体温症犬连续血液滤过复温中的对比研究(1)
[摘要]目的 研究连续血液滤过(CRRT)复温过程中，采用全身肝素抗凝或局部枸橼酸抗凝对腹部开放伤合并海水浸泡致意外低体温症犬救治效果的影响。方法 选取比格犬19只，制备腹部开放伤合并海水浸泡致低体温症犬模型，按复温方式随机分为三组：CRRT复温全身肝素抗凝组 (A组，n=7)；CRRT复温局部枸橼酸抗凝组 (B组，n=7)，温水浴复温组(C组，n=5)。分别于正常体温，降温至34℃，复温至30℃、34℃和38℃时检测血常规、血生化、凝血功能、动脉血气和血流动力学指标。结果 三组各时间点的纤维蛋白原(Fib)、血清钾(K+)、总胆红素(TBil)及平均动脉压(MAP)差异无统计学意义(P>0.05)；复温至34℃和38℃时，C组的血尿素氮(BUN)较A、B组明显升高，差异有统计学意义(P<0.05)。结论 CRRT复温中，采用全身肝素抗凝或局部枸橼酸抗凝，对腹部开放伤合并海水浸泡致意外低体温症犬Fib、K+、TBil、BUN、MAP的影响无差别。
[关键词]连续血液滤过复温；意外低体温症；全身肝素抗凝；局部枸橼酸抗凝；海水浸泡
[中图分类号] R-332 [文献标识码] A [文章编号] 1674-4721(2017)08(c)-0004-04
[Abstract]Objective To investigate the effect of systemic Heparin anticoagulation or local Citrate anticoagulation on the treatment of sudden hypothermia in beagles with open abdominal trauma and seawater immersion during continuous renal replacement therapy rewarming (CRRT).Methods Nineteen beagles were enrolled in this study.The animal model of open abdominal trauma coupled with hypothermia induced by seawater immersion was established. Dogs were randomly divided into three groups according to rewarming ways：systemic Heparin anticoagulation group (group A，n=7 )，regional Citrate anticoagulation group (group B，n=7)，warm water bath rewarming group (group C，n=5).The blood routine，blood chemistry，coagulation function，blood gas and hemodynamics indexes were detected at normal temperature，hypothermia to 34℃，rewarming to 30℃，34℃，38℃.Results There was no significant difference in Fib，K+，TBil and MAP among the three groups at each time point (P>0.05).When rewarming to 34℃ and 38℃，BUN in group C was significantly higher than that in group A and B (P<0.05).Conclusion During the progress of CRRT rewarming，there are no difference between Heparin anticoagulantion or Citrate anticoagulation on Fib，K+，BUN，TBil and MAP for accidental hypothermia dogs with open abdominal trauma and hypothermia induced by seawater immersion.
[Key words]Continuous renal replacement therapy rewarming；Accidental hypothermia；Systemic Heparin anticoagulation；Regional Citrate anticoagulation；Seawater immersion
海战伤主要指登陆作战部队及舰艇部队所受创伤[1]，海战伤主要特点之一为伤员落水经低温海水浸泡后出现意外低体温症[2]。“低体温、酸中毒、凝血功能障碍”被称为意外低体温症的“死亡三联症”[3]。国外有使用CRRT救治意外低体温患者的个案报道[4-8]，国内鲜有报道。本研究探讨全身肝素抗凝或局部枸橼酸抗凝对腹部开放伤合并海水浸泡致意外低体温症犬救治效果的影响，现报道如下。
1材料与方法
1.1 实验方法
1.1.1低温海水配制 实验用人工配制海水，海盐由国家海洋局第三研究所提供。主要指标：pH 8.20，渗透压(1250.00±11.52)mmol/L，钾离子浓度(10.88±0.68)mmol/L，钠离子浓度(630.00±5.33)mmol/L，氯离子浓度(658.80±5.25)mmol/L。
1.1.2动物分组 比格犬19只，由海军总医院动物实验室提供，合格证号11400800001413-11400800001432，按復温方式随机分为三组。A组：CRRT联合温水浴复温；CRRT过程中采用全身肝素抗凝(n=7)；B组：CRRT联合温水浴复温，CRRT过程中采用局部枸橼酸抗凝(n=7)；C组：单独使用(40±2)℃热水进行复温(n=5)。, http://www.100md.com(袁瑞 帅维正 张志成)
[关键词]连续血液滤过复温；意外低体温症；全身肝素抗凝；局部枸橼酸抗凝；海水浸泡
[中图分类号] R-332 [文献标识码] A [文章编号] 1674-4721(2017)08(c)-0004-04
[Abstract]Objective To investigate the effect of systemic Heparin anticoagulation or local Citrate anticoagulation on the treatment of sudden hypothermia in beagles with open abdominal trauma and seawater immersion during continuous renal replacement therapy rewarming (CRRT).Methods Nineteen beagles were enrolled in this study.The animal model of open abdominal trauma coupled with hypothermia induced by seawater immersion was established. Dogs were randomly divided into three groups according to rewarming ways：systemic Heparin anticoagulation group (group A，n=7 )，regional Citrate anticoagulation group (group B，n=7)，warm water bath rewarming group (group C，n=5).The blood routine，blood chemistry，coagulation function，blood gas and hemodynamics indexes were detected at normal temperature，hypothermia to 34℃，rewarming to 30℃，34℃，38℃.Results There was no significant difference in Fib，K+，TBil and MAP among the three groups at each time point (P>0.05).When rewarming to 34℃ and 38℃，BUN in group C was significantly higher than that in group A and B (P<0.05).Conclusion During the progress of CRRT rewarming，there are no difference between Heparin anticoagulantion or Citrate anticoagulation on Fib，K+，BUN，TBil and MAP for accidental hypothermia dogs with open abdominal trauma and hypothermia induced by seawater immersion.
[Key words]Continuous renal replacement therapy rewarming；Accidental hypothermia；Systemic Heparin anticoagulation；Regional Citrate anticoagulation；Seawater immersion
海战伤主要指登陆作战部队及舰艇部队所受创伤[1]，海战伤主要特点之一为伤员落水经低温海水浸泡后出现意外低体温症[2]。“低体温、酸中毒、凝血功能障碍”被称为意外低体温症的“死亡三联症”[3]。国外有使用CRRT救治意外低体温患者的个案报道[4-8]，国内鲜有报道。本研究探讨全身肝素抗凝或局部枸橼酸抗凝对腹部开放伤合并海水浸泡致意外低体温症犬救治效果的影响，现报道如下。
1材料与方法
1.1 实验方法
1.1.1低温海水配制 实验用人工配制海水，海盐由国家海洋局第三研究所提供。主要指标：pH 8.20，渗透压(1250.00±11.52)mmol/L，钾离子浓度(10.88±0.68)mmol/L，钠离子浓度(630.00±5.33)mmol/L，氯离子浓度(658.80±5.25)mmol/L。
1.1.2动物分组 比格犬19只，由海军总医院动物实验室提供，合格证号11400800001413-11400800001432，按復温方式随机分为三组。A组：CRRT联合温水浴复温；CRRT过程中采用全身肝素抗凝(n=7)；B组：CRRT联合温水浴复温，CRRT过程中采用局部枸橼酸抗凝(n=7)；C组：单独使用(40±2)℃热水进行复温(n=5)。, http://www.100md.com(袁瑞 帅维正 张志成)