摘要目的 观察结扎肠系膜淋巴管对急性失血大鼠血小板功能、体外血栓形成以及凝血功能的影响,探讨肠淋巴途径在急性失血时血液凝固性变化中的作用.方法 按随机数字表法将20只雄性Wistar大鼠分为失血组与结扎组,每组10只.采用经右颈总动脉匀速放血(失血量为全血量的1/4)的方法制备急性失血大鼠模型.结扎组失血后行肠系膜淋巴管结扎,失血组仅在肠系膜淋巴管下穿线但不结扎;记录24 h大鼠存活情况.失血后24 h将存活大鼠再次全麻,经左颈总动脉迅速放血6 ml.检测实验前后血小板黏附率、血小板聚集率、体外血栓形成率及凝血功能指标的变化,计算脑血流量.结果 急性失血后24 h,失血组存活6只(60%),结扎组存活9只(90%),结扎组存活率高于失血组,但差异无统计学意义(P>0.05).与实验前相比,两组血小板黏附率、血小板聚集率、纤维蛋白原(Fib)均显著升高,凝血酶时间(TT)显著延长,脑血流量显著降低;失血组活化部分凝血活酶时间(APTT)显著延长,血栓湿长、干长、湿重、干重和血栓形成率均显著增加(P<0.05或P<0.01).实验后结扎组血小板黏附率[(15.02±1.24)%],血小板聚集率(1 min、3 min及最大聚集率),血栓湿长、干长、湿重、干重,血栓形成率[(46.2±6.9)%],APTT[(21.04±5.53)s],Fib含量[(433.67±13.97)g/L]均显著低于失血组[分别为(18.54±1.18)%、(69.8±6.9)%、(26.35±6.26)s、(510.96±35.59) g/L],脑血流量[(485.1±41.4)ml·kg~(-1)·min-1]显著高于失血组[(417.8±42.2)ml·kg~(-1)·min-1,P<0.05或P<0.01].结论 急性失血可导致大鼠血液高凝、体外血栓形成增多,肠系膜淋巴管结扎可改善急性失血大鼠的血液高凝状态.

abstractsObjective To observe the effects of mesenteric lymph duct ligation on platelet function, thrombus formation in vitro and coagulation function in rats with acute loss of blood, and investigate the role of intestinal lymphatic pathway on coagulability change during acute loss of blood. Methods Twenty male Wistar rats were randomly divided into loss of blood group (n=10) and ligation group (n=10). The acute loss of blood model was reproduced by withdrawing blood (one fourth of body whole blood volume) with an automatic withdrawal-infusion machine through right common carotid artery. In ligation group, the mesenteric lymph duct was ligated after loss of blood, and in loss of blood group only a thread was passed under the mesenteric lymph duct. The rats′ survival rate at 24 hours was recorded. After 24 hours, surviving rats were anesthetized again, and 6 ml of blood was withdrew from left common carotid artery rapidly. The platelet adhesive rate, platelet aggregation rate, thrombus formation in vitro, coagulation function were determined before and after experiment, and the cerebral blood flow was measured. Results There were 6 rats alive in loss of blood group (60%), and 9 rats alive in ligation group (90%). The platelet adhesive rate, platelet aggregation rate, fibrinogen (Fib) content were increased in both groups, and cerebral blood flow was lower compared with before experiment significantly. The activated partial thromboplastin time (APTT) in loss of blood group, and thrombin time (TT) in both groups were prolonged. And the length of wet thrombus, wet weight of thrombus, length of dry thrombus, dry weight of thrombus and thrombus formation rate in loss of blood group were significantly increased compared with before experiment (P<0.05 or P<0.01). But in ligation group, the platelet adhesive rate [(15.02±1.24)%], platelet aggregation rate (at 1 minute, 3 minutes and max aggregation rate), length of wet thrombus, wet weight of thrombus, length of dry thrombus, dry weight of thrombus, thrombus formation rate [(46.2±6.9)%], APTT [(21.04±5.53)s] and Fib content [(433.67±13.97) g/L] were lower, cerebral blood flow [(485.1±41.4) ml·kg~(-1)·min-1] was higher compared with loss of blood group, respectively [(18.54±1.18)%, (69.8±6.9)%, (26.35±6.26)s, (510.96±35.59) g/L, (417.8±42.2) ml·kg~(-1)·min~(-1), P<0.05 or P<0.01]. Conclusion The results indicate that acute loss of blood leads to coagulation and increased thrombosis, and mesenteric lymph duct ligation can improve hypercoagubility of blood.