浓缩红细胞储存时间对大量输血患者临床指标的影响

Impact of packed erythrocyte storage duration on clinical indexes of patients with massive blood transfusion

目的观察浓缩红细胞储存时间对大量输血患者临床指标的影响。方法将167例大量输血患者根据输注的浓缩红细胞的储存时间分为A组73例及B组94例,A组浓缩红细胞储存时间<14 d,B组浓缩红细胞储存时间≥14 d。比较两组患者大量输血24 h后血常规、凝血功能、动脉血气分析、血电解质水平、住院期间死亡率及术后住院时间,观察两组患者大量输血2周内的输血不良反应及术后并发症发生情况。结果两组患者大量输血24 h后血Hb、PLT、凝血酶原时间(PT)及活化部分凝血酶时间(APTT)比较,差异均无统计学意义(P>0.05)。动脉血气分析显示,A组大量输血24 h后的血pH值及Na^+浓度高于B组,而K^+浓度低于B组(P<0.05),但两组患者血Cl^-及Ca^(2+)浓度比较,差异无统计学意义(P>0.05)。两组患者输血不良反应、术后并发症发生率、住院期间死亡率及术后住院时间比较,差异均无统计学意义(P>0.05)。结论大量输注储存时间≥14 d的浓缩红细胞更易导致患者出现电解质紊乱及酸碱失衡等,对于酸中毒、肝肾功能不全及高钾血症患者,应尽量保证输注较新鲜的血液制品。

Objective To observe the impact of packed erythrocyte storage duration on the clinical indexes of patients with massive blood transfusion.Methods A total of 167 patients with massive blood transfusion were divided into group A(n=73)and group B(n=94)according to the storage duration of packed erythrocytes infused.The storage duration of packed erythrocytes infused in group A was less than 14 days,and in group B equal to or more than 14 days.The blood routine,coagulation function,arterial blood gas analysis,blood electrolyte level,in hospital mortality and postoperative hospital stay were compared between the two groups after 24 hours of massive blood transfusion.The incidence of adverse effects of blood transfusion and postoperative complications was observed in the two groups within two weeks of massive blood transfusion.Results There was no significant difference in Hb,PLT,prothrombin time(PT)or activated partial thromboplastin time(APTT)between the two groups after 24 hours of massive blood transfusion(P>0.05).The arterial blood gas analysis showed that the blood pH value and Na+concentration were higher and K+concentration was lower in group A than those in group B after 24 hours of massive blood transfusion(P<0.05),but no significant difference was observed in the blood concentration of Cl-or Ca 2+between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions or postoperative complications,in hospital mortality,or postoperative hospital stay between the two groups(P>0.05).Conclusion The storage duration of massive packed erythrocyte infused equal to or more than 14 days might more easily lead to electrolyte disorder and acid-base imbalance in the patients.It is necessary to ensure the infused blood products fresh as far as possible for patients with acid poisoning,liver and kidney dysfunction and hyperkalemia.