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目的 创伤引起的凝血功能障碍是死亡的重要原因.本研究主要观察猪创伤失血性休克后凝血功能的变化.方法 12只家猪随机(随机数字法)分为对照组(CG,n=6)和实验组(EG,n=6).实验组先受到胸部钝性伤,然后放全血的35％左右,维持平均动脉压(MAP)在(40±3) mmHg(1 mmHg=0.133 kPa)2 h,随后进行复苏.对照组没有创伤、失血及复苏.分别在实验开始时(H0)、创伤失血后15 min (H1)、1 h(H2)、2 h(H3)以及复苏后15 min (R1)、2h (R2)、6 h(R3)、24h (R4)采血,进行血气分析、血常规(Plt)、凝血试验(PT、APTT、Fib)和血栓弹力图(TEG)检测.结果 实验组动物Plt持续下降,复苏后各时间点与对照组差异均有统计学意义(P ＜0.05);Fib创伤放血后15 min开始显著下降直至复苏后2h,期间各时间点均低于对照组(P＜0.05),复苏后24 h显著高于对照组(P＜0.05);PT在创伤放血后15 min显著缩短(P=0.001),之后逐渐延长,复苏后6h开始缩短,放血后2h至复苏后6h期间各时间点与对照组比较,差异有统计学意义(P＜0.05);APTT在创伤放血后15 min显著缩短(P=0.024),后显著延长直至复苏后6h,各时间点差异有统计学意义(P＜0.05).实验组TEG的R值在创伤放血后15 min显著缩短(P＜0.05),复苏后24h较对照组显著延长(P =0.022);K值在创伤放血后15 min显著缩短(P=0.001);MA值在创伤放血后2h显著低于对照组(』P=0.004).结论 创伤失血性休克早期存在一过性高凝状态,表现为PT、APTT、R值和K值的缩短,随后转变为低凝状态,表现为PT、APTT的延长和Fib、MA值的下降.复苏期仍处于低凝状态,早期表现为PT、APTT的延长和Plt、Fib的下降,晚期表现为R值的延长和Plt的下降.“,”Objective To investigate the changes of blood coagulation after traumatic hemorrhagic shock in swine in order to elucidate the coagulopathy to be the predominant cause of death after severe trauma.Methods Twelve domestic swine were randomly (random number) divided into the control group (CG,n =6) and experimental groups (EG,n =6).The swine in EG were hit with blunt injury on chest first,and hemorrhagic shock was induced by exsanguinating until 35％ of the estimated total blood volume lost so as to maintain mean arterial pressure (MAP) at about (40 ± 3) mmHg for two hours,and then the swine were resuscitated.The swine in CG were not injured.Blood samples were taken before injury (H0) and 15 min (H1),1 h (H2),2 h (H3) after traumatic hemorrhage and 15 min (R1),2 h (R2),6 h (R3),24 h (R4) after resuscitation.The blood gas analysis,blood routine (Plt),coagulation tests (PT,APTT,Fib) and thromboelastogram (TEG) were measured.Results Compared with CG,Plt (platelet) in EG was continuously reducing after hemorrhage,and was significantly lower after resuscitation (P ＜ 0.05).Fib dropped quickly after hemorrhagic shock and the levels of Fib were lower during H1 to R2 and higher at R4 (P ＜0.05).PT decreased significantly at H1 (P=0.001),then was higher at H3,RI,R2 and R3 (P ＜0.05).APTT was shortened remarkably at H1 (P =0.024),and then prolonged from H2 to R3 (P ＜ 0.05).Among the TEG parameters,R values were shortened at H1 (P ＜ 0.05),and prolonged at R4 (P =0.022) ; K values decreased at H1 (P =0.001) and MA values decreased at H3 (P =0.004).Conclusion Hyper-coagulation was characterized by shortened PT,APTT,R and decreased K values existed transiently at early stage of traumatic hemorrhagic shock,then turned into hypo-coagulation presenting prolonged PT and APTT and decreased Fib and MA.Hypo-coagulation persisted during resuscitation and showed prolonged PT and APTT and decreased Plt and Fib at initial stage and prolonged R values and decreased Plt at late stage.