脾外伤回收血的变化及其对凝血功能的影响

目的：探讨脾外伤应用自体血回输技术，病人的回收血巾血细胞及其相关指标的变化和其对凝血功能的影响。方法：2008年至2009年收治的24例单纯脾外伤行全脾切除的病人，分别在术前、回收血、回输后2h采集血样，分析其血细胞计数、血红蛋白、凝血功能及血小板激活指标（P-选择素、血小板第4因子）的变化。结果：①回收血中红细胞计数、血小板计数、白细胞计数、血红蛋白、红细胞比容比循环血低；②回收血中P选择素、血小板第4因子增加；凝血因子Ⅶ活性、凝血因子Ⅻ活性降低，凝血酶原片段F1＋2升高，凝血酶原时间、凝血酶时问、活化部分凝血活酶时间延长；纤维蛋白原减低；⑧回收血液中红细胞呈棘状细胞状；洗涤后，部分红细胞恢复至正常双凹圆盘状；④血液回输后与回收血相比，RBC计数及Het明显升高。结论：①回收血与循环血不同，表现为全血细胞数目不同，血小板被激活，循环血中凝血酶原片段F1＋2水平升高，考虑凝血系统被激活；②回收血液并不会使循环血液内的血小板激活：③自体血液回收技术对RBC形态无明显影响。

Changes in salvaged blood of patients with splenic rupture and their effects on coagulation function

Objective To investigate the changes in salvaged blood of patients with splenic rupture, and their effects on coagulation function. Methods Twenty-four splenic rupture patients were admitted from 2008 to 2009 in our hospital. Blood samples were collected before operation, from the salvaged blood and 2 hours after blood transfusion, respectively. The changes of blood cell count, coagulation function and platelet activation indicators （P-selectin, platelet granule PF4） were detected. Results ①The blood cell count, platelet count, hemoglobin and hematocrit （Hct） in the salvaged blood were lower than those in circulating blood;②The values of P-seleetin, PF4 and prothrombin fragment Fl＋2 in the salvaged blood were increased. Meanwhile, the value of fibrinogen, activity of factors Ⅶ and Ⅻ were decreased. The thrombin time, prothrombin time, as well as the activated partial thromboplastin time were prolonged; ③The morphological examination indicated that RBC in the salvaged blood was in echinocytic shape, and most of the transformation was reversible after centrifuging and washing; ④ The amount of red blood cells and Hct in the circulating blood were increased significantly through autologous blood transfusion. Conclusions ① The salvaged blood is different from the circulating blood, demonstrating as the changes of blood cell count and activation of platelets.. The elevated level of prothrombin fragment F1＋ 2 may trigger the coagulation system; ②The salvaged blood does not activate the platelets in the circulating blood;③ Reinfusion produces little effect on the morphology of erythrocytes.