Monaca Enrico, Strelow Hartmut, Jüttner Tobias, Hoffmann Till, Potempa Tim, Windolf Joachim, Winterhalter Michael
Undersea Hyperb Med. 2014 Jan-Feb;41(1):17-26.
Exposure to hyperbaric conditions influences the coagulation system. Thromboembolic events and disseminated intravascular coagulation were observed.
To detect the effects of a hyperbaric environment on the human coagulation system using the point-of-care coagulation analyzers Multiplate and ROTEM.
PATIENTS/METHODS: 20 patients were included. Each received 90 minutes of oxygen intermittently at 2.4 atmospheres absolute, as per the TS 240-90 wound-healing protocol. Blood samples were taken before and after hyperbaric exposure and ROTEM, Multiplate and standard laboratory assays were subsequently performed.
ROTEM showed a significant increase of the maximum clot firmness (EXTEM MCF; p < 0.05) and the thromboelastometric platelet component of the clot firmness (MCF(EXTEM) - MCF(FIBTEM); p < 0.01). Multiplate showed a platelet activation mediated by thrombin (AU TRAP-test; p < 0.05) and by arachidonic acid (AUC ASPI-test; p < 0.01). Standard laboratory assays revealed a lower activated partial thromboplastin time (p < 0.05) and a higher leukocyte count (p < 0.05). No further changes were detected. A t-test was performed after testing if data followed normal distribution.
ROTEM and Multiplate were able to detect an activation of platelets after HBO2 therapy via thrombin and arachidonic acid pathways. Previously reported fibrinolysis could not be confirmed.
暴露于高压环境会影响凝血系统。已观察到血栓栓塞事件和弥散性血管内凝血。
使用即时凝血分析仪Multiplate和ROTEM检测高压环境对人体凝血系统的影响。
患者/方法：纳入20名患者。按照TS 240 - 90伤口愈合方案，每位患者在绝对压力2.4个大气压下间歇性吸氧90分钟。在高压暴露前后采集血样，随后进行ROTEM、Multiplate检测及标准实验室检测。
ROTEM显示最大血凝块硬度（EXTEM MCF；p < 0.05）以及血凝块硬度的血栓弹性图血小板成分（MCF(EXTEM) - MCF(FIBTEM)；p < 0.01）显著增加。Multiplate显示由凝血酶介导的血小板活化（AU TRAP检测；p < 0.05）以及由花生四烯酸介导的血小板活化（AUC ASPI检测；p < 0.01）。标准实验室检测显示活化部分凝血活酶时间降低（p < 0.05）以及白细胞计数升高（p < 0.05）。未检测到进一步变化。在检测数据是否符合正态分布后进行t检验。
ROTEM和Multiplate能够检测到高压氧治疗后通过凝血酶和花生四烯酸途径引起的血小板活化。先前报道的纤维蛋白溶解未得到证实。
