摘要
目的探讨大量输血后患者相关生化指标的变化及临床意义。方法选择2015年4月-2016年4月在本院输血量为2 000 ml~5 000 ml的患者40例作为研究对象,对比分析输血前后电解质(包括Na~+、K~+、Ca~(2+)、Cl~-)、凝血功能[包括凝血时间(PT)、凝血酶原活动度时间(APTT)、出血时间(TT)及纤维蛋白原(Fbg)水平]、血气分析[包括动脉血p H值、血乳酸(Lac)、碱剩余(BE)]指标。结果与输血前比较,BE值增高,Lac值低;输血后K~+水平高于输血前,Ca~(2+)水平低于输血前;输血后患者PT、APTT均大于输血前,上述差异均有统计学意义(P<0.05)。输血前后p H值差异无统计学意义;TT和Fbg输血前后差异无统计学意义(P>0.05)。结论大量输血导致患者内环境变化,需要注意电解质及凝血功能障碍。
Objective To investigate the changes and clinical significance of biochemical indexes in patients with massive blood transfusion. Methods 40 patients with 2 000 ml-5 000 ml blood transfusion from April 2015 to April 2016 in our hospital were selected as the research objects,and electrolyte( including Na~+,K~+,Ca~(2+),Cl~-),coagulation function including coagulation time( PT),prothrombin time activity( APTT),bleeding time( TT) and fibrinogen( Fbg) level,blood gas analysis indicators including arterial blood p H,blood lactic acid( Lac),residual alkali index( BE) were analyzed and compared. Results Comparing with that before blood transfusion,BE value increased,Lac value decreased; level of K~+after blood transfusion was higher than that before transfusion; Ca~(2+)was lower than that before blood transfusion; PT,APTT were higher than that before transfusion,and there was statistical significance in the difference( P < 0. 05). There was no statistical significance on the difference in p H value before and after transfusion; there was no statistical significance in difference of Fbg and TT before and after blood transfusion( P > 0. 05). Conclusion Massive blood transfusions will lead to changes in patient' s environment,which need to pay attention to electrolyte and coagulation disorders.
引文
[1]韩杰,李春华.大量输血患者及时输注血浆的重要性[J].四川医学,2011,32(7):1044-1046.
[2]戴蕴,王占科,乐爱平,等.严重创伤失血患者大量输血后血糖水平、多器官功能障碍综合征发生率和病死率的观察[J].解放军医药杂志,2016,28(5):83-86.
[3]赖俊浩,张翀,胡斌,等.大量输血程序对腹部外科创伤性休克患者的应用价值探讨[J].中华普通外科杂志,2014,29(9):715-718.
[4]崔焕波.手术患者大量输血后不同时间血清电解质浓度动态变化探讨[J].中外医疗,2016,35(12):20-21.
[5]梁燕霞,伍绍东.大量输血前后血钾浓度变化研究[J].国际检验医学杂志,2016,37(6):836-837.
[6]崔允霞.大量输血导致血钾变化的临床分析[J].中国现代药物应用,2016,10(12):91-93.
[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]陈琼,朱长太,钟宁,等.大量输血患者血清电解质浓度动态监测[J].临床输血与检验,2015,17(5):401-403.
[9]朱正洪,苏简文,陈丽娟,等.产后出血患者大量输血前后凝血指标的变化观察[J].现代中西医结合杂志,2015,24(17):1863-1865.
[10]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.
[11]刘颖,曹建明,彭阿钦,等.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(6):845-848.
[12]王硕,王欣然,韩斌如,等.大量输血病人并发出血的护理进展[J].中华护理杂志,2006,41(2):167-169.
[13]张桂芬.大量输血患者输血前后凝血功能和血小板变化[J].海南医学院学报,2014,20(10):1368-1370.
[14]王建华.钙离子在大量输血患者中的应用研究[J].当代医学,2012,18(17):103-104.
[15]曾德理,庞丽丽,曾惠琼,等.短期内大量输血患者血清电解质变化分析[J].现代仪器与医疗,2015,21(2):50-52.