目的 探讨高原环境下猪肠管火器贯通伤的早期凝血功能变化特点.方法 选取20头健康长白仔猪,按随机数字表法分为平原组、高原组,每组10只.平原组放置于海拔800 m的平原境中,高原组放置于模拟海拔6 000 m高原的实验舱中48 h.两组均手枪致腹部肠管火器贯通伤后返回平原观察室.各组伤后0、2、4、8、12及24 h分别检测外周血凝血和纤溶指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)、D-二聚体(D-D)、纤维蛋白降解产物(FDP)]、血栓弹力图(TEG)[凝血反应时间(R值)、血凝块形成时间(K值)、血凝块形成速率(α角)、血凝块最大强度(MA)、凝血综合指数(CI)]、血小板参数[血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、大型血小板比率(P-LCR)].结果 高原组伤后0、2hPT均较平原组显著降低,伤后8、12、24 h PT均较平原组显著升高(P＜0.01);伤后4 h PT与平原组差异无统计学意义(P＞0.05).高原组伤后0、2、4 h APTT均较平原组显著降低,伤后8、12、24 h APPT均较平原组显著升高(P＜0.01).高原组伤后0、2、4 h TT均较平原组显著降低,伤后12、24 h TT均较平原组显著升高(P＜0.01);伤后8hTT与平原组差异无统计学意义(P＞0.05).高原组伤后0、2、4、8、12、24hFbg、D-D、FDP均较平原组显著升高(P＜0.01).高原组伤后0、2、4hR值均较平原组显著降低,伤后8、12、24 hR值均较平原组显著升高(P＜0.01).高原组伤后0、2、4hK值均较平原组显著降低,伤后8、12、24hK值均较平原组显著升高(P＜0.05或0.01).高原组伤后0、2、4hα角均较平原组显著升高,伤后8、12、24 h α角均较平原组显著降低(P＜0.01).高原组伤后0、2、4、8 h MA值均较平原组显著升高,伤后12、24 h MA值均较平原组显著降低(P＜0.01).高原组伤后0、2、4 h CI值均较平原组显著升高,伤后8、12、24 h CI值均较平原组显著降低(P＜0.01).高原组伤后0、2、4、8 h PLT均较平原组显著升高,伤后12、24 h PLT均较平原组显著降低(P＜0.05或0.01).高原组伤后0、2、4、8、12、24 h MPV均较平原组显著升高(P＜0.01).高原组伤后2、4、8、12、24h PDW均较平原组显著升高(P＜0.05或0.01),伤后0hPDW与平原组差异无统计学意义(P＞0.05).高原组伤后0、2、4、8、12、24hP-LCR均较平原组显著升高(P＜0.01).结论 与平原环境相比,高原环境下猪肠管火器贯通伤早期更易出现高凝状态并伴随轻度纤溶亢进,更快进入低凝状态并伴随明显纤溶亢进.
Early coagulation function changes of penetrating intestinal firearm injury of pigs in high-altitude environment
Objective To explore the early coagulation function changes of penetrating intestinal firearm injury of pig in high-altitude environments.Methods Twenty healthy long white piglets were selected and divided into the plain group and the high-altitude group using the random number table method,with 10 pigs in each group.Pigs in the plain group were placed in a plain environment at an altitude of 800 meters,while pigs in the high-altitude group were placed in an experimental chamber simulating an altitude of 6 000 meters for 48 hours.Both groups received pistol gunshot to have firearm penetrating wounds to the abdominal intestinal tract and then returned to the plain observation room.At 0,2,4,8,12 and 24 hours after injury,coagulation in the peripheral blood and fibrinolytic indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fbg),D-dimer(D-D),and fibrinogen degradation product(FDP)],thromboelastogram(TEG)[reaction time(R),clotting time(K),clot formation rate(α),maximum amplitude(MA)and coagulation composite index(CI)],platelet parameters[platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW),and platelet-large cell ratio(P-LCR)]in the two groups were detected separately.Results The PT values at 0 and 2 hours after injury in the high-altitude group were significantly lower than those in the plain group,while they were significantly higher at 8,12 and 24 hours than those in the plain group(P＜0.01);there was no significant difference at 4 hours between the two groups(P＞0.05).The APTT values at 0,2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group,while they were significantly higher at 8,12 and 24 hours after injury than those in the plain group(P＜0.01).The TT values at 0,2 and 4 hours after the injury in the high-altitude group were significantly lower than those in the plain group,while they were significantly higher at 12 and 24 hours after injury than those in the plain group(P＜0.01);there was no significant difference at 8 hours after injury between the two groups(P＞0.05).The Fbg,D-D and FDP values at 0,2,4,8,12 and 24 hours after injury were higher in the high-altitude group than those in the plain group(P＜0.01).The R values at 0,2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group,while they were significantly higher at 8,12 and 24 hours after injury than those in the plain group(P＜0.01).The K values at 0,2,4 and 8 hours after injury in the high-altitude group were significantly lower than those in the plain group,while they were significantly higher at 12 and 24 hours after injury than those in the plain group(P＜0.05 or 0.01).Theα angles at 0,2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group,while they were significantly lower at 8,12 and 24 hours after injury than those in the plain group(P＜0.01).The MA values at 0,2 and 4 hours after the injury in the high-altitude group were significantly higher than those in the plain group,while they were significantly lower at 8,12 and 24 hours after injury than those in the plain group(P＜0.01).The CI values at 0,2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group,while they were significantly lower at 8,12 and 24 hours after injury than those in the plain group(P＜0.01).The PLT values at 0,2,4 and 8 hours after injury in the high-altitude group were significantly higher than those in the plain group,while they were significantly lower at 12 and 24 hours after injury than those in the plain group(P＜O.05 or 0.01).The MPV values at 0,2,4,8,12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group(P＜0.01).The PDW values at 2,4,8,12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group(P＜0.05 or 0.01),while there was no significant difference in PDW at 0 hour after injury between the two groups(P＞O.05).The P-LCR values at 0,2,4,8,12 and 24 hours after injury in the high-altitude group were all significantly higher than those in the plain group(P＜0.01).Conclusion Compared with the plain environments,pig intestinal firearm penetrating injury in the high-altitude environments is more prone to early hypercoagulable state accompanied by mild hyperfibrinolysis,and faster to reach a hypocoagulable state accompanied by obvious hyperfibrinolysis.
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