血小板计数和血清钙离子水平与大量输血后患者凝血功能紊乱关系的研究
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摘要
目的:探讨血小板计数(PLT)、血清钙离子(Ca~(2+))与大量输血后患者凝血功能的关系。方法:选取2012年3月-2015年3月本院输血治疗的104例大出血患者为研究对象,输血量1000~2000 m L的50例大出血患者为输血组,输血量≥2000 m L的54例大出血患者为大量输血组,另选54例健康检查者为对照组。两组输血1 h后,分别检测各组的PLT和Ca~(2+)浓度的变化情况。结果:与对照组比较,输血组和大量输血组PLT和Ca~(2+)浓度均明显下降,差异均有统计学意义(P<0.05);输血组和大量输血组PLT和Ca~(2+)浓度比较,差异均无统计学意义(P>0.05)。通过相关分析得出,在输血组和大量输血组中PLT和Ca~(2+)均无相关性(r=0.058,P=0.512;r=0.061,P=0.384)。通过Logistic回归分析得出,PLT、Ca~(2+)浓度与大量输血后患者出现凝血功能紊乱独立相关。(OR=0.134,P=0.019;OR=0.140,P=0.008)。与输血组相比,大量输血组的低血小板血症和低血钙血症的发生率明显升高,差异均有统计学意义(字2=36.563,P=0.000;字2=35.884,P=0.000)。结论:PLT和Ca~(2+)浓度可作为大量输血后患者出现凝血功能紊乱的风险评估指标。
Objective:To investigate the relationships of PLT and Ca~(2+) levels in patients with coagulation function dysfunction after massive transfusion Method:A total of 104 patients with hemorrhage for blood transfusion treatment were chosen as the research objects,among them 50 cases for 1000 to 2000 m L as blood transfusion group and 54 cases for 2000 m L or greater of blood transfusion as massive blood transfusion group.In addition,54 healthy peoples were chosen as the control group.After one hour blood transfusion,the change of serum PLT and Ca~(2+) were tested in two groups.Result:Compared with the control group,PLT and Ca~(2+) levels decreased significantly in blood transfusion group and massive blood transfusion group(P<0.05).No statistical significance was found between blood transfusion group and massive blood transfusion group(P>0.05).PLT and Ca~(2+) levels in blood transfusion group and massive blood transfusion group had no correlation(r=0.058,P=0.512;r=0.061,P=0.384).By the Logistic regression analysis,PLT and Ca~(2+) levels were correlated independently with coagulationfunction dysfunction(OR=0.134,P=0.019;OR=0.140,P=0.008).Compared with blood transfusion group,the low blood platelet and hypocalcaemia were more likely to appear in massive blood transfusion group(字2=36.563,P=0.000;字2=35.884,P=0.000).Conclusion:Plasma PLT and Ca~(2+) levels can be used in risk assessment of coagulation function dysfunction.
Objective:To investigate the relationships of PLT and Ca~(2+) levels in patients with coagulation function dysfunction after massive transfusion Method:A total of 104 patients with hemorrhage for blood transfusion treatment were chosen as the research objects,among them 50 cases for 1000 to 2000 m L as blood transfusion group and 54 cases for 2000 m L or greater of blood transfusion as massive blood transfusion group.In addition,54 healthy peoples were chosen as the control group.After one hour blood transfusion,the change of serum PLT and Ca~(2+) were tested in two groups.Result:Compared with the control group,PLT and Ca~(2+) levels decreased significantly in blood transfusion group and massive blood transfusion group(P<0.05).No statistical significance was found between blood transfusion group and massive blood transfusion group(P>0.05).PLT and Ca~(2+) levels in blood transfusion group and massive blood transfusion group had no correlation(r=0.058,P=0.512;r=0.061,P=0.384).By the Logistic regression analysis,PLT and Ca~(2+) levels were correlated independently with coagulationfunction dysfunction(OR=0.134,P=0.019;OR=0.140,P=0.008).Compared with blood transfusion group,the low blood platelet and hypocalcaemia were more likely to appear in massive blood transfusion group(字2=36.563,P=0.000;字2=35.884,P=0.000).Conclusion:Plasma PLT and Ca~(2+) levels can be used in risk assessment of coagulation function dysfunction.
引文
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[10]杨汉华.大量输血后患者血清电解质的变化[J].中外医疗,2009,29(36):42-44.
[11]王伟,胡旭梅,王敬波,等.大量输血对创伤大出血患者血钾和酸碱平衡的影响[J].临床血液学杂志,2015,28(8):660-662.
[12]张文莉,杜彦懿,赵东晓.浅谈大量输血后电解质和酸碱平衡的改变[J].内蒙古中医药,2010,29(20):3-4.
[13]黄建平,胡建华,万向农,等.手术大量输血后患者电解质及凝血功能的变化[J].国际检验医学杂志,2015,36(5):606-607.
[14]大量输血现状调研协作组,杨江存,徐永刚,等.全国多中心大量输血凝血指标调研分析[J].中国输血杂志,2012,25(7):632-635.
[15]徐翠香,杨江存.传统大量输血观念更新[J].中国输血杂志,2012,25(7):624-627.
[16]Brhi K,Singh J,Heron M,et al.Acute traumatic coagulopathy[J].J Trauma,2003,54(6):1127-1130.
[17]Mac Leod J B,Lynn M,Mc Kenney M G,et al.Early coagulopathy predicts mortality in trauma[J].J Trauma,2003,54(1):39-44.
[18]田维涛,张碧霞,张彤.大量输血前后患者凝血四项及血小板检测结果分析[J].西南国防医药,2009,19(2):228-229.
[19]梁智,方芳.大量输血对凝血功能影响的临床分析[J].吉林医学,2014,35(4):733-735.
[2]胡旭梅,赵海涛,王敬波,等.大量输血对严重失血患者凝血功能和电解质平衡的影响[J].山西医药杂志,2015,44(17):2030-2032.
[3]Stanworth S J,Morris T P,Gaarder C,et al.Reappraising the concept of massive transfusion in trauma[J].Crit Care,2010,14(6):239-240.
[4]Surgenor S D,Kramer R S,Olmstead E M,et al.The association of perioperative red blood cell transfusions and decreased longterm survival after cardiac surgery[J].Analg,2009,108(6):1741-1746.
[5]苏晓丽,刘媛,孙杨,等.中国部分地区三级综合医院外科大量输血死亡组与非死亡组用血情况调研分析[J].现代检验医学杂志,2015,30(6):154-159.
[6]刘颖,曹建明,彭阿钦.大量输血对严重创伤患者凝血功能影响的研究[J].河北医药,2014,36(6):845-848.
[7]卢春生,林列坤,曹文平,等.大量输血引起的血清电解质及凝血功能变化的研究[J].检验医学与临床,2013,10,(3):291-292.
[8]石俊平.大量输血后纤维蛋白原和血小板的临床分析[J].中国实用医药,2015,25(10):101-102.
[9]于丽君,朱国标,李翠莹,等.大量输血患者血小板和出凝血功能变化分析[J].国际检验医学杂志,2013,34(23):3252-3254.
[10]杨汉华.大量输血后患者血清电解质的变化[J].中外医疗,2009,29(36):42-44.
[11]王伟,胡旭梅,王敬波,等.大量输血对创伤大出血患者血钾和酸碱平衡的影响[J].临床血液学杂志,2015,28(8):660-662.
[12]张文莉,杜彦懿,赵东晓.浅谈大量输血后电解质和酸碱平衡的改变[J].内蒙古中医药,2010,29(20):3-4.
[13]黄建平,胡建华,万向农,等.手术大量输血后患者电解质及凝血功能的变化[J].国际检验医学杂志,2015,36(5):606-607.
[14]大量输血现状调研协作组,杨江存,徐永刚,等.全国多中心大量输血凝血指标调研分析[J].中国输血杂志,2012,25(7):632-635.
[15]徐翠香,杨江存.传统大量输血观念更新[J].中国输血杂志,2012,25(7):624-627.
[16]Brhi K,Singh J,Heron M,et al.Acute traumatic coagulopathy[J].J Trauma,2003,54(6):1127-1130.
[17]Mac Leod J B,Lynn M,Mc Kenney M G,et al.Early coagulopathy predicts mortality in trauma[J].J Trauma,2003,54(1):39-44.
[18]田维涛,张碧霞,张彤.大量输血前后患者凝血四项及血小板检测结果分析[J].西南国防医药,2009,19(2):228-229.
[19]梁智,方芳.大量输血对凝血功能影响的临床分析[J].吉林医学,2014,35(4):733-735.