The Possible Mechanism Of The Change Of Coagulation Function In Pigs With Traumatic Hemorrhagic Shock At High Altitude And The Observation Of The Therapeutic Effect Of Tranexamic Acid

Objective:Through observing and researching the possible mechanism of coagulation function changes in traumatic hemorrhagic shock pigs and the therapeutic effect of tranexamic acid on them at high altitude,to provide a clinical theoretical basis for further understanding and treating plateau traumatic coagulation dysfunction.Method:24 male bama pigs aged from 4 to 6 months were randomly divided into 4 groups,namely control group(H0)and shock group(H1 group: blood loss is 20% of total blood volume,H2 group: blood loss is 35% of total blood volume,H3 group: blood loss is 35% of total blood volume + tranexamic acid intravenous infusion),with 6 pigs in each group.Control group no blood,no wounds,and shock group establish the model of plateau trauma hemorrhagic shock.Prior to the bloodletting(T0)?bloodletting complete immediate(T1)?bloodletting complete after 30 min(T2)?bloodletting complete after 60 min(T3)and bleeding complete after 120 min(T4)venous blood was drawn respectively in H1?H2 group,venous blood was drawn at the same time in H0 group.Through the central venous give tranexamic acid 15 mg/Kg after bloodletting completed after 30 min in H3 group,and infusion time is 10 min.The rest of the process are same with H2 group in H3 group.At T0,T1,T2,T3,T4 time point,test the seven indicators of coagulation(PT?APTT?TT?INR?FIB?FDP?D-Dimer)?TEG index(R?K?Angle?MA?LY30?CI?EPL)and the concentration of activated protein C(aPC)?multiple ligands proteoglycan-1(SDC-1)?chondroitin sulfate(CS)?heparan sulfate(HS)?hyaluronic acid(HA)?D-Dimer and blood lactic acid(LA)in plasma.Result:Seven indicators of coagulation:Compared with the H0 group,FIB in H1 and H2 groups decreased and TT increased(P<0.05).Compared with H1 group,TT and PT increased in H2 group(P<0.05).Compared with H2 group,TT decreased in H3 group(P<0.05).In the H1 group,compared with the time point of T0,FIB decreased at the T1?T2?T3 and T4 time point(P<0.05).In H2 group,TT and PT at T1?T2?T3 and T4 time point increased compared with T0(P<0.05).In H3 group,compared with the T2 time point,the FIB at T3 time point was increased(P<0.05).TEG index:Compared with the H0 group,the R value was decreased in H1 and H2 group(P<0.05),while the K value was decreased in H3 group(P<0.05).Compared with H1 group,MA value was decreased in H2 group(P<0.05),and R value was decreased in H3group(P<0.05).Compared with H2 group,R and K values was decreased,while MA values increased in H3 group(P<0.05).In H1 group,compared with time point of T0,R value was decreasedat at T1 time point,while R value was increased at T3 and T4 time point(P<0.05).In H2 group,compared with T0 time point,R value at T1 time point was decreased(P<0.05).In the H3 group,the R values at T2?T3 and T4 time points was decreased compared with T0 time point(P<0.05).Biochemical indicators:Compared with the H0 group,the concentration of CS?HA?HS?aPC and LA was increased in H1 and H2 groups(P<0.05),and the concentration of SDC-1 was increased in H2 group(P<0.05).Compared with H1 group,the concentration of CS?HA?HS?aPC and D-Dimer was increased in H2 group(P<0.05).Compared with H2 group,the concentration of CS?HA?HS?aPC?SDC-1,D-Dimer and LA values was decreased in H3 group(P<0.05).In the H1 group,compared with the time point of T0,the concentration of CS was increased at the time point of T3 and T4(P<0.05).In the H2 group,compared with the time point of T0,the time points of T2?T3 and T4 the concentration of CS was increased(P<0.05),while the time points of T3 the concentration of HS was increased(P<0.05).In the H3 group,compared with the time points of T2,the time points of T3 and T4 the concentration of D-Dimer was decreased(P<0.05),and the time points of T3 the concentration of LA was decreased(P<0.05).Conclusion:Plateau trauma hemorrhagic shock pigs at the loss of blood immediately showed hypercoagulable factor function,with the extension of bleeding time the clotting factor function and platelet function was reduced.The greater blood loss,the hyperfibrinolysis showed earlier,Plateau trauma hemorrhagic shock pig's coagulation dysfunction can be improved by intravenous infusion tranexamic acid;Hemorrhagic shock caused the glucose calyx of endothelial cells shedding increased,the levels of aPC?D-Dimer,and LA values was increased in experimental pigs.Intravenous tranexamic acid can reduce the glucose calyx shedding of endothelial cells,and the onset time was 20 min after administration.