复方氨基酸联用大剂量维生素B<sub>6</sub>治疗家兔创伤性凝血功能障碍的作用

doi:10.3877/cma.j.issn.2095-9133.2020.05.008

中华卫生应急电子杂志 ›› 2020, Vol. 06 ›› Issue (05) : 288 -292. doi: 10.3877/cma.j.issn.2095-9133.2020.05.008

所属专题：文献；

论著

复方氨基酸联用大剂量维生素B₆治疗家兔创伤性凝血功能障碍的作用

吴杨¹, 易石坚¹^,^†(

), 李兰兰², 梁乾坤¹, 吴松燕³, 肖月³

^1. 518055　广东深圳，深圳大学总医院普通外科
^2. 518103　广东深圳，深圳市福永人民医院感控科
^3. 518055　广东深圳，深圳大学总医院门诊部

收稿日期:2020-02-14 出版日期:2020-10-18
通信作者: 易石坚
基金资助:
深圳市科技计划项目(JCYJ20170818102312352)

Compound amino acids combined with high dose vitamin B₆ in treatment of traumatic coagulation dysfunction: an experimental study

Yang Wu¹, Shijian Yi¹^,^†(), Lanlan Li², Qiankun Liang¹, Songyan Wu³, Yue Xiao³

^1. Department of General Surgery, Shenzhen University General Hospital, Shenzhen 518055, China
^2. Department of Noscocomial Infection Control, Shenzhen FU Yong Peoplefection Con, Shenzhen 518103, China
^3. Department of outpatient, Shenzhen University General Hospital, Shenzhen 518055, China

Received:2020-02-14 Published:2020-10-18
Corresponding author: Shijian Yi
About author:
Corresponding author: Yi Shijian, Email: yishijian1969@szu.edu.cn

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引用本文：

吴杨, 易石坚, 李兰兰, 梁乾坤, 吴松燕, 肖月. 复方氨基酸联用大剂量维生素B₆治疗家兔创伤性凝血功能障碍的作用[J]. 中华卫生应急电子杂志, 2020, 06(05): 288-292.

Yang Wu, Shijian Yi, Lanlan Li, Qiankun Liang, Songyan Wu, Yue Xiao. Compound amino acids combined with high dose vitamin B₆ in treatment of traumatic coagulation dysfunction: an experimental study[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2020, 06(05): 288-292.

目的

探讨复方氨基酸注射液联用大剂量维生素B₆对创伤性凝血功能障碍动物模型凝血功能的影响。

方法

实验动物为家兔，分为对照组(10只)、凝血障碍组(30只)、凝血障碍治疗组(30只)，凝血障碍组和凝血障碍治疗组以创伤(开腹术)＋足动脉放血制作家兔创伤失血模型。凝血障碍组经耳缘静脉输注放血等量的等渗盐水，凝血障碍治疗组经耳缘静脉输注等量复方氨基酸注射液＋大剂量维生素B₆，分别于治疗后12 h、24 h、48 h和72 h采血测定各凝血指标，72 h后取肝脏组织进行病理检测。

结果

治疗后三组相比较，凝血障碍治疗组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)低于凝血障碍组，差异有统计学意义，与对照组比较差异无统计学意义；各组纤维蛋白原(FIB)在伤后72 h内结果差异无统计学意义。在伤后12 h、24 h测定各组凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ活性，凝血障碍治疗组较凝血障碍组活性更高，其差异有统计学意义(P<0.05)，与对照组比较差异无统计学意义；在伤后72 h内测定谷丙转氨酶(ALT)、谷草转氨酶(AST)、胆红素(TBIL)，凝血障碍治疗组较凝血障碍组偏低，其差异有统计学意义(P<0.05)；凝血因子Ⅺ活性、血小板(PLT)伤后72 h内结果差异无统计学意义。72 h后肝脏病理检测，凝血障碍组肝细胞严重肿胀，呈球形，胞质几乎完全透明，呈气球样变；凝血障碍治疗组肝细胞水肿，胞质疏松呈网状；对照组部分肝细胞轻度水肿。

结论

复方氨基酸联用大剂量维生素B₆能够明显改善创伤失血后家兔肝功能及凝血功能，提高凝血因子活性，有效保护肝细胞。

关键词: 创伤和损伤, 维生素B₆, 复方氨基酸注射液, 凝血功能障碍

Objective

To establish an animal model of coagulopathy, and to observe the effect of compound amino acid injection plus high-dose vitamin B6 on coagulation function in an animal model.

Methods

The experimental animals were rabbits, which were divided into the control group (10), the coagulation disorder group (30), and the coagulation disorder treatment group (30). The coagulation disorder group and the coagulation disorder treatment group were treated with trauma (laparotomy) and foot artery bloodletting was performed to establish a rabbit trauma blood loss model. In the treatment group, the same amount of normal saline was injected via the ear vein; while in the treatment group, the same amount of compound amino acid injection plus high-dose vitamin B6 was injected via the ear vein. Blood samples were collected at 12 hours, 24 hours, 48 hours and 72 hours after the treatment, and the liver histopathology was observed at 72 hours.

Results

After treatment, compared with the three groups of coagulopathy treatment group, coagulation disorder group, and control group, the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) were lower than those of coagulation in the disorder groups, and the difference was statistically significant; but the difference was not statistically significant from that of the control group; the fibrinogen (FIB) results of the groups within 72 hours after injury were not statistically significant. The coagulation factor Ⅱ, Ⅶ, Ⅸ, and X activities of each group were measured at 12 and 24 hours after injury. The coagulopathy treatment group had higher activity than the coagulation disorder group, and the difference was statistically significant (P <0.05); compared with the control group no statistical significance was detected. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin (TBIL) were measured within 72 hours after injury. These in coagulopathy treatment group was lower than those of coagulation disorder group, and the difference was statistically significant (P<0.05); For coagulation there was no statistically significant difference in factor Ⅺ activity and platelet (PLT)within 72 hours after injury. After 72 hours, liver pathological examination showed that the hepatocytes in the coagulation disorder group were severely swollen, spherical, and the cytoplasm was almost completely transparent, showing a balloon-like change; the hepatocytes in the coagulation disorder treatment group were edema and the cytoplasm was reticular; the liver cells in the control group were slight edema.

Conclusion

Compound amino acids combined with high-dose vitamin B6 can significantly improve the liver function and coagulation function of rabbits after traumatic blood loss, increase the activity of coagulation factors and effectively protect liver cells.

Key words: Wounds and injuries, Vitamin B6, Compound amino acid injection, Coagulation dysfunction

表1 凝血障碍治疗组、凝血障碍组、对照组，APTT、PT、TT、FIB结果比较(±s)

组别	时间(建模后)	APTT(S)	TT(S)	PT(S)	FIB(g/L)
对照组	12 h	18.74±1.05	18.4±2.1	10.70±1.89	2.34±0.26
	24 h	18.21±0.75	17.2±1.9	9.70±1.19	2.44±0.28
	48 h	17.77±0.46	18.1±2.3	10.10±0.89	2.35±0.19
	72 h	18.66±0.43	17.9±1.5	9.20±0.86	2.31±0.52
凝血障碍组	12 h	36.92±2.42	25.5±1.82	15.86±2.56	2.14±0.76
	24 h	38.39±3.81	25.5±1.82	16.85±2.55	2.24±0.21
	48 h	38.50±1.85	25.5±1.82	16.86±2.60	2.15±0.49
	72 h	37.95±2.72	25.5±1.82	16.27±3.30	2.27±0.22
凝血障碍治疗组	12 h	19.41±0.75^a	19.14±2.7^a	10.50±1.88^a	2.34±0.56
	24 h	17.91±0.52^a	18.25±1.8^a	9.82±0.84^a	2.64±0.18
	48 h	17.69±0.01^a	17.99±2.9^a	10.11±1.08^a	2.35±0.19
	72 h	28.76±0.87	18.22±1.6	10.08±0.83	2.76±0.12

表1 凝血障碍治疗组、凝血障碍组、对照组，APTT、PT、TT、FIB结果比较(±s)

组别	时间(建模后)	APTT(S)	TT(S)	PT(S)	FIB(g/L)
对照组	12 h	18.74±1.05	18.4±2.1	10.70±1.89	2.34±0.26
	24 h	18.21±0.75	17.2±1.9	9.70±1.19	2.44±0.28
	48 h	17.77±0.46	18.1±2.3	10.10±0.89	2.35±0.19
	72 h	18.66±0.43	17.9±1.5	9.20±0.86	2.31±0.52
凝血障碍组	12 h	36.92±2.42	25.5±1.82	15.86±2.56	2.14±0.76
	24 h	38.39±3.81	25.5±1.82	16.85±2.55	2.24±0.21
	48 h	38.50±1.85	25.5±1.82	16.86±2.60	2.15±0.49
	72 h	37.95±2.72	25.5±1.82	16.27±3.30	2.27±0.22
凝血障碍治疗组	12 h	19.41±0.75^a	19.14±2.7^a	10.50±1.88^a	2.34±0.56
	24 h	17.91±0.52^a	18.25±1.8^a	9.82±0.84^a	2.64±0.18
	48 h	17.69±0.01^a	17.99±2.9^a	10.11±1.08^a	2.35±0.19
	72 h	28.76±0.87	18.22±1.6	10.08±0.83	2.76±0.12

表2 凝血障碍治疗组、凝血障碍组、对照组，凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ、Ⅺ活性结果比较(±s)

组别	时间(建模后)	Ⅱ(%)	Ⅶ(%)	Ⅸ(%)	Ⅹ(%)	Ⅺ(%)
对照组	12 h	93.74±31.05	67.74±12.46	152.14±42.29	37.74±11.08	57.74±19.68
	24 h	88.71±30.21	59.59±11.77	142.01±43.84	36.47±10.59	56.84±18.81
	48 h	91.94±28.12	65.44±14.01	149.87±40.58	32.19±16.01	52.49±17.52
	72 h	92.04±29.45	63.45±12.40	151.01±39.54	35.64±14.16	54.55±16.49
凝血障碍组	12 h	73.98±21.12	51.24±12.02	122.03±38.18	27.56±10.98	61.09±12.48
	24 h	70.12±22.69	49.55±11.19	119.01±31.09	22.49±12.24	62.97±13.94
	48 h	90.84±27.79	66.48±13.49	139.81±42.08	33.05±14.91	59.48±12.92
	72 h	89.48±27.01	66.47±10.80	144.05±38.11	33.74±12.86	59.18±15.48
凝血障碍治疗组	12 h	94.90±29.95^a	65.51±11.86^a	149.87±41.01^a	36.84±10.92^a	57.06±13.15
	24 h	98.72±33.11^a	61.48±12.62^a	132.98±28.85^a	35.99±12.52^a	56.94±18.09
	48 h	90.49±25.52	64.98±15.48	139.98±45.08	33.21±19.41	55.09±16.10
	72 h	90.94±27.05	65.19±13.54	149.15±35.87	38.15±13.91	58.46±17.44

表2 凝血障碍治疗组、凝血障碍组、对照组，凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ、Ⅺ活性结果比较(±s)

组别	时间(建模后)	Ⅱ(%)	Ⅶ(%)	Ⅸ(%)	Ⅹ(%)	Ⅺ(%)
对照组	12 h	93.74±31.05	67.74±12.46	152.14±42.29	37.74±11.08	57.74±19.68
	24 h	88.71±30.21	59.59±11.77	142.01±43.84	36.47±10.59	56.84±18.81
	48 h	91.94±28.12	65.44±14.01	149.87±40.58	32.19±16.01	52.49±17.52
	72 h	92.04±29.45	63.45±12.40	151.01±39.54	35.64±14.16	54.55±16.49
凝血障碍组	12 h	73.98±21.12	51.24±12.02	122.03±38.18	27.56±10.98	61.09±12.48
	24 h	70.12±22.69	49.55±11.19	119.01±31.09	22.49±12.24	62.97±13.94
	48 h	90.84±27.79	66.48±13.49	139.81±42.08	33.05±14.91	59.48±12.92
	72 h	89.48±27.01	66.47±10.80	144.05±38.11	33.74±12.86	59.18±15.48
凝血障碍治疗组	12 h	94.90±29.95^a	65.51±11.86^a	149.87±41.01^a	36.84±10.92^a	57.06±13.15
	24 h	98.72±33.11^a	61.48±12.62^a	132.98±28.85^a	35.99±12.52^a	56.94±18.09
	48 h	90.49±25.52	64.98±15.48	139.98±45.08	33.21±19.41	55.09±16.10
	72 h	90.94±27.05	65.19±13.54	149.15±35.87	38.15±13.91	58.46±17.44

表3 凝血障碍治疗组、凝血障碍组、对照组，ALT、AST、DBIL、PLT结果比较(±s)

组别	时间(建模后)	ALT(U/L)	AST(U/L)	TBIL(umol/L)	PLT(10⁹/L)
对照组	12 h	161.65±30.21	74.65±40.21	4.65±0.59	271.55±91.05
	24 h	154.65±34.26	71.12±42.43	3.95±0.89	254.62±87.15
	48 h	167.21±26.71	76.53±39.89	4.25±0.13	274.69±77.55
	72 h	151.68±32.63	72.61±41.84	4.32±0.17	251.22±92.41
凝血障碍组	12 h	232.46±29.22	94.51±31.55	5.81±0.63	239.12±83.11
	24 h	266.92±31.62	96.22±32.84	6.35±0.12	288.66±51.24
	48 h	292.27±34.71	106.33±29.98	7.88±0.29	269.24±76.09
	72 h	296.61±33.16	112.25±32.83	8.32±0.41	281.46±65.14
凝血障碍治疗组	12 h	162.15±26.31^a	74.21±30.22^a	4.11±0.53^a	277.89±71.45
	24 h	170.32±34.26^a	76.11±32.19^a	4.75±0.82^a	272.12±78.32
	48 h	172.21±24.73^a	76.31±29.84^a	4.88±0.25^a	261.62±91.15
	72 h	176.69±31.19	77.27±31.81	4.32±0.19	281.82±81.67

表3 凝血障碍治疗组、凝血障碍组、对照组，ALT、AST、DBIL、PLT结果比较(±s)

组别	时间(建模后)	ALT(U/L)	AST(U/L)	TBIL(umol/L)	PLT(10⁹/L)
对照组	12 h	161.65±30.21	74.65±40.21	4.65±0.59	271.55±91.05
	24 h	154.65±34.26	71.12±42.43	3.95±0.89	254.62±87.15
	48 h	167.21±26.71	76.53±39.89	4.25±0.13	274.69±77.55
	72 h	151.68±32.63	72.61±41.84	4.32±0.17	251.22±92.41
凝血障碍组	12 h	232.46±29.22	94.51±31.55	5.81±0.63	239.12±83.11
	24 h	266.92±31.62	96.22±32.84	6.35±0.12	288.66±51.24
	48 h	292.27±34.71	106.33±29.98	7.88±0.29	269.24±76.09
	72 h	296.61±33.16	112.25±32.83	8.32±0.41	281.46±65.14
凝血障碍治疗组	12 h	162.15±26.31^a	74.21±30.22^a	4.11±0.53^a	277.89±71.45
	24 h	170.32±34.26^a	76.11±32.19^a	4.75±0.82^a	272.12±78.32
	48 h	172.21±24.73^a	76.31±29.84^a	4.88±0.25^a	261.62±91.15
	72 h	176.69±31.19	77.27±31.81	4.32±0.19	281.82±81.67

图1 三组家兔肝脏组织病理观察比较

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Compound amino acids combined with high dose vitamin B₆ in treatment of traumatic coagulation dysfunction: an experimental study

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Compound amino acids combined with high dose vitamin B6 in treatment of traumatic coagulation dysfunction: an experimental study

Compound amino acids combined with high dose vitamin B₆ in treatment of traumatic coagulation dysfunction: an experimental study