不同比例输血策略对创伤-失血性休克大鼠的凝血指标、血浆代谢指标影响及作用机制分析

摘要 目的：探讨不同比例输血策略对创伤-失血性休克大鼠的凝血指标、血浆代谢指标影响及作用机制。方法：选择Sprague- Dawley大鼠24只，制备创伤-失血性休克动物模型，采用血气分析仪检测凝血指标（PT及ATPP）血气分析指标（包括pH、PO₂、PCO₂、乳酸），采用比色法检测常见代谢酶活性，采用PCR法检测mRNA含量，记录并对比目标血压为80 mmHg时B、C、D三组大鼠的输血量。结果：与A组大鼠相比，B、D组大鼠的ATPP、PT水平明显较高(P<0.05)，A组与C组间对比无统计学意义(P>0.05)；与B组大鼠相比，D组大鼠的ATPP、PT水平明显较低(P<0.05)。与A组相比，B、C、D组大鼠的pH、PO₂水平明显降低、PCO₂及乳酸水平明显升高对比(P>0.05)；与B组大鼠相比，C、D组大鼠的pH、PO2明较高，PCO2、乳酸明显较低(P<0.05)；C、D组间对比无统计学意义(P>0.05)。四组大鼠的血浆肌酸激酶、天门冬氨酸基转移酶、碱性磷酸酶、丙氨酸氨基转移酶活动水平对比无统计学意义(P>0.05)。与A组相比，B、D组大鼠的血浆miR-24水平明显较高，肝脏FX mRNA水平明显较低(P<0.05)，C组大鼠的血浆miR-24与肝脏FX mRNA与A组对比无统计学意义(P>0.05)；与B组相比，D组大鼠的血浆miR-24水平明显较低，肝脏FX mRNA水平明显较高(P<0.05)。达到目标血压为80 mmHg时，输血量B组>C组>D组(F=133.139，P<0.001)。结论：新鲜冰冻血浆：红细胞比为1:1的输血策略较1：2.5的输血策略对创伤-失血性休克大鼠的复苏效果更好，可能与其降低大鼠的循环miR-24水平，提高肝脏FX mRNA水平表达有关。

Effects of Different Proportion of Blood Transfusion Strategies on Coagulation and Plasma Metabolism in Traumatic-hemorrhagic Shock Rats and Analysis of Mechanism

ABSTRACT Objective: To investigate the effect of different ratio blood transfusion strategies on blood coagulation indexes and plasma metabolism indexes in trauma-hemorrhagic shock rats and the mechanism of action. Methods: Twenty-four Sprague-Dawley rats were selected to prepare trauma-hemorrhagic shock animal models. Blood gas analyzer was used to detect coagulation indexes (PT and ATPP) and blood gas analysis indexes (including pH, PO₂, PCO₂, lactic acid), and colorimetric method was used. The activity of common metabolic enzymes was detected, the mRNA content was detected by PCR method, and recorded and compared the blood transfusion volume of rats in groups B, C and D when the target blood pressure is 80 mmHg. Results: Compared with rats in group A, the levels of ATPP and PT of rats in groups B and D were significantly higher (P<0.05), and there was no statistically significant difference between group A and group C (P>0.05); compared with group B Compared with rats, the levels of ATPP and PT in group D were significantly lower (P<0.05). Compared with group A, the pH and PO₂ levels of rats in groups B, C, and D were significantly reduced, and the levels of PCO₂ and lactic acid were significantly increased (P>0.05); compared with rats in group B, rats in group C and D pH and PO₂ were higher, PCO₂ and lactic acid were significantly lower (P<0.05); the comparison between groups C and D was not statistically significant (P>0.05). The plasma creatine kinase, aspartate transferase, alkaline phosphatase, and alanine aminotransferase activity levels of the four groups of rats were not statistically significant (P>0.05). Compared with group A, the plasma miR-24 level of rats in groups B and D was significantly higher, and the liver FX mRNA level was significantly lower(P<0.05). The plasma miR-24 and liver FX mRNA of rats in group C were not statistically compared with group A(P>0.05). Compared with group B, the plasma miR-24 level of rats in group D was significantly lower, and the level of liver FX mRNA was significantly higher (P<0.05). When the target blood pressure is 80 mmHg, blood transfusion group B>C group>D group (F=133.139, P<0.001). Conclusion: The blood transfusion strategy of fresh frozen plasma: red blood cell ratio of 1:1 is better than the blood transfusion strategy of 1:2.5 on trauma-hemorrhagic shock rats. It may reduce the circulating miR-24 level in rats and increase it The expression of liver FX mRNA level is related.