云南白药对血小板释放及代谢反应影响.docVIP

云南白药对血小板释放及代谢反应影响 　作者：唐正龙, 王兴,伊彪, 李自力, 梁成 【摘要】 目的： 研究云南白药对血小板颗粒内容物释放和代谢反应的影响，探讨其止血和抗炎机理。方法： 87例正颌外科手术患者随机分为试验组(43例)和对照组(44例)，分别在术前3日口服云南白药胶囊和安慰剂胶囊；采集术前和术中静脉血，用酶联免疫吸附法测定手术开始前和术中血浆11-去氢-血栓烷B2 (11DehydroThromboxane B2, 11DHTXB2)水平；分离和固定血小板，观察血小板超微结构和颗粒内容物的改变。结果： 术前实验组血浆11DHTXB2（58.83±15.89）ng/L，对照组(69.54±14.43)ng/L，两组比较差异无统计学意义；术中实验组11DHTXB2(90.41±38.97)ng/L，对照组(131.78±78.92)ng/L，两组差异有统计学意义；实验组术中血小板内α-颗粒数目减少，两组比较具有统计学差异。结论： 云南白药抑制血小板11DHTXB2的生成，反映了血栓烷A2生成减少，不会增加手术区域微血管的收缩，可能有利于改善术后局部血液循环;在手术刺激诱导下云南白药可促进血小板颗粒内容物的释放，有利于提高术中凝血功能，减少手术中出血量。 【关键词】 云南白药；血小板活化；血小板聚集；细胞结构 　　［Abstract］Objective: To observe the changes of platelet release and metabolic reaction after administration of Yunnan Baiyao in orthognathic surgery and to investigate the haemostasis and antiinflammation mechanisms of Yunnan Baiyao. Methods: Eightyseven patients scheduled for bimaxillary orthognathic surgery were enrolled in the prospective, randomized clinical study. Patients were orally administrated with Yunnan Baiyao capsules (group YB, n=43) or placebo capsules (group C, n=44) 3 days before operation. Plasma levels of 11DehydroThromboxane B2 （11DHTXB2） were determined using ELISA pre and intraoperation. The intraoperative ultrastructural aspects and the αgranules number of blood platelets were also observed with electromicroscope. Results: The preoperative plasma level of 11DHTXB2 in group YB (58.83±15.89 pg/ml) was lower than that of group C (69.54±14.43pg/ml), but the difference was not significant. The intraoperative plasma level of 11DHTXB2 in group YB was significantly lower than that in group C (90.41±38.97 pg/ml vs. 131.78±78.92 pg/ml). The intraoperative average number of αgranule in group YB was also significantly lower than that in group C. Conclusion: The administration of Yunnan Biayao capsules inhibits the metabolic production of blood platelet 11DHTXB2 reflecting the decrease of thromboxan A2 which does not increase the microvascular shrink in operation area,