不同比例成分输血对急性大出血患者疗效的探讨
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摘要
目的探讨不同比例成分输血对大出血患者的疗效情况,为临床救治大出血患者治疗提供治疗依据。方法选取2015年1月—2017年12月期间本院接受大量输血患者71例,根据输注血浆和去白细胞红细胞悬液比例分为3组,分别为低比例组16例(FFP∶RBC<1∶3)、中比例组37例(1∶3≤FFP∶RBC≤1∶2)、高比例组18例(1∶2≤FFP∶RBC≤1∶1),比较患者入院后24小时凝血功能的情况,另外将此71例根据输注冷沉淀凝血因子与否分为A、B 2组,比较这2组凝血功能的变化情况。结果无论输血前后,3组内PT、APTT、TT、FIB和PLT都有明显统计学意义(P<0.05)。中高比例组PT、APTT、TT延长时间短于低比例组有统计学意义(P<0.05)。输注冷沉淀凝血因子(A组)与未输冷沉淀凝血因子(B组)患者24小时后凝血功能比较。A组PT、APTT、TT延长时间短于B组有统计学意义(P<0.05)。结论大量输血早期,合理搭配血浆与红细胞的比例,会有效促进患者的止血;如果增加冷沉淀输注会更加提升治疗效果。
Objective To explore the curative effect of different proportion of component blood transfusion in patients with massive hemorrhage,and to provide therapeutic basis for clinical treatment of patients with massive hemorrhage. Methods A total of 71 patients received massive blood transfusion in our hospital were selected and divided into 3 groups according to the proportion of transfusion plasma and leukocytic RBCs. There were 16 cases in the low proportion group( FFP: RBC< 1: 3),37 cases in the middle proportion group( 1: 3≤FFP: RBC≤1: 2) and 18 cases in the high proportion group( 1: 2≤FFP: RBC≤1: 1),the coagulation function at 24 hours after hospitalization was compared. In addition,the 71 cases were divided into two groups according to the infusion of cold precipitation coagulation factor or not. The changes of coagulation function in these two groups were compared. Results All PT,APTT,TT,FIB and PLT were significantly difference among the three groups both before and after blood transfusion( P< 0.05). The prolongation time of PT,APTT,TT in the middle and high proportion group was shorter than that in the low proportion group( P<0.05). Comparison of the prolongation time of PT,APTT,TT after 24 hours infusion coagulation function between cold-precipitated coagulation factor( Group A) and non-cryoprecipitation coagulation factor( Group B). The prolongation of PT,APTT,TT in group A was significantly shorter than that in group B( P < 0. 05). Conclusions In the early stage of massive blood transfusion,a reasonable ratio of plasma to red blood cell could effectively promote the hemostasis of patients. If increasing the cold-precipitated coagulation factor infusion,it will improve the therapeutic effect.
Objective To explore the curative effect of different proportion of component blood transfusion in patients with massive hemorrhage,and to provide therapeutic basis for clinical treatment of patients with massive hemorrhage. Methods A total of 71 patients received massive blood transfusion in our hospital were selected and divided into 3 groups according to the proportion of transfusion plasma and leukocytic RBCs. There were 16 cases in the low proportion group( FFP: RBC< 1: 3),37 cases in the middle proportion group( 1: 3≤FFP: RBC≤1: 2) and 18 cases in the high proportion group( 1: 2≤FFP: RBC≤1: 1),the coagulation function at 24 hours after hospitalization was compared. In addition,the 71 cases were divided into two groups according to the infusion of cold precipitation coagulation factor or not. The changes of coagulation function in these two groups were compared. Results All PT,APTT,TT,FIB and PLT were significantly difference among the three groups both before and after blood transfusion( P< 0.05). The prolongation time of PT,APTT,TT in the middle and high proportion group was shorter than that in the low proportion group( P<0.05). Comparison of the prolongation time of PT,APTT,TT after 24 hours infusion coagulation function between cold-precipitated coagulation factor( Group A) and non-cryoprecipitation coagulation factor( Group B). The prolongation of PT,APTT,TT in group A was significantly shorter than that in group B( P < 0. 05). Conclusions In the early stage of massive blood transfusion,a reasonable ratio of plasma to red blood cell could effectively promote the hemostasis of patients. If increasing the cold-precipitated coagulation factor infusion,it will improve the therapeutic effect.
引文
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[2]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):154-155.
[3]王烯冬,夏医君,薛荣泉,等.新鲜冷冻血浆血小板及冷沉淀在大出血患者中的联合应用研究[J].检验医学与临床,2014,11(5):647-648.
[4] Pacheco LD,Saade GR,Costantine MM,et al. An update on the use of massive transfusion protocols in obstetrics[J]. American Journal of Obstetrics&Gynecology,2016,214(3):340-344.
[5]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.
[6] Smith JE,Fawcett R,Randalls B. The use of recombinant activated factor VII in a patient with penetrating chest trauma and ongoing pulmonary hemorrhage[J].2012,177(5):614-616.
[7] Cata JP,Wang H, Gottumukkala V, et al. Editor's choice:Inflammatory response,immunosuppression,and cancer recurrence after perioperative blood transfusions[J]. Br J Anaesth,2013,110(5):690-701.