全肠外营养对患者血小板和血凝指标的影响

目的研究全肠外营养（TVN）对患者血小板和血凝指标的影响。方法实验对象分3组，对照组15例为普通饮食的健康志愿者，短期TPN组15例为行TPN支持5～7d的重症非感染患者，长期TPN组15例为行TPN支持1～3个月的重症非感染患者。采用流式细胞仪测定P-选择素阳性表达的血小板百分数（Ps％），同时测定肝功能指标（ALT、AST）、血小板计数（PLT）、临床常用血凝指标（PT、APTT、Fib、TT）。结果短期TPN组P-选择素阳性血小板百分数、血小板计数和临床常用血凝四项与对照组均无显著差异。长期TPN组P-选择素阳性血小板百分数显著高于对照组（P〈0．01），血小板计数显著低于对照组（P〈0．05）。且相关分析提示P-选择素阳性血小板百分数与TPN使用时间呈显著正相关（P〈0．01），而临床常用血凝4项与对照组均无显著差异。结论长期TPN可导致血小板活化程度增高和血小板计数减少，且血小板活化程度与TPN使用时间呈正相关。

Effects of total parenteral nutrition on platelet and indexes of coagulation

Objecitve To study the effects of total parenteral nutrition on platelet and indexes of coagulation. Objects and methods There are three groups. The control group included fifteen healthy volunteers who were oral fed. The short-term TPN group included 15 patients who received TPN support for 5-7 days. And 15 patients who received TPN support for 1 to 3 months were included in the long-term TPN Group. The positive expression of P- selectin, （Ps%） was measured by flow cytometry. And alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, the count of platelet （Pit）, prothrombin time （PT）, activated partial thrombin time （APTT）, the concentration of fibrinogen （Fib） and thrombin time （TT） were conducted. Results All the above indexes of the short - term TPN group had no significant difference with that of the control group. The rate of platelet with positive P - selectin （Ps%） and the count of platelet （Pit） of the long- term TPN group was significantly higher than that of the control group （P〈0.01, P〈 0.05, respectively） ; and statistical analysis revealed a significant positive association of Ps% with the time of TPN support in the long-term TPN group （ r = 0.82, P 〈0.01）. The other indexes of the long-term TPN group had no significant difference with that of the control group. Conclusion A long term TPN increases the activity of platelet and decreases the count of platelet; and the activity of platelet is positive correlative to the time of TPN support.