创伤失血性休克患者不同血浆与悬浮红细胞输注比例对凝血功能的影响

Effect of different infusion ratio of plasma and suspended red blood cells on coagulation function in patients with traumatic hemorrhagic shock

目的探究创伤失血性休克患者不同血浆和悬浮红细胞的输注比例对凝血功能的改善作用。方法选取2019年1月至2021年1月在鄂州市妇幼保健院急诊科确诊的122例创伤失血性休克患者,根据治疗使用的血浆与悬浮红细胞输注比例将患者分为三组:低比例组(1∶3,n=29)、中比例组(1∶2,n=42)和高比例组(1∶1,n=51)。在输血前和输血后1 d时采集创伤失血性休克患者的静脉血,利用血凝仪检测创伤失血性休克患者的凝血功能指标,利用丹麦RADIOMETER ABL9型血气自动分析仪检测患者体内的Hb和pH水平,记录所有患者的血液制品使用情况、死亡情况以及住院时间。结果输血1 d后,三组的凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)均明显高于输血前,纤维蛋白原(FIB)含量明显低于输血前,差异有统计学意义(P<0.05);高比例组输血1 d后患者体内的PT和APTT明显低于低、中比例组,而FIB含量明显高于低、中比例组,差异有统计学意义(P<0.05);中比例组输血1 d后其PT和APTT明显低于低比例组,而FIB含量明显高于低比例组,差异有统计学意义(P<0.05);在住院24 h内,低比例组、中比例组和高比例组输注的悬浮红细胞等血液制品情况的差异无统计学意义(P>0.05);在住院期间,高比例组的红细胞输注总量明显低于另外低、中比例组,差异有统计学意义(P<0.05);三组创伤性休克患者输血前及输血24 h后的Hb含量及p H大小相比,差异无统计学意义(P>0.05);低比例组、中比例组和高比例组的住院时间和死亡率相比,差异无统计学意义(P>0.05)。结论在治疗创伤失血性休克患者时,与输注低比例血浆与悬浮红细胞相比,适当输注比例可明显减低PT和APPT,提高FIB含量,从而改善患者的凝血功能。

Objective To explore the effect of different infusion ratio of plasma and suspended red blood cells on the improvement of coagulation function in patients with traumatic hemorrhagic shock(THS).Methods A total of 122 THS patients diagnosed in the Emergency Department of Ezhou Maternal and Child Health-Care Hospital from January 2019 to January 2021 were selected and divided into three groups according to the infusion ratio of plasma and suspended red blood cells:low proportion group(1∶3,n=29),medium proportion group(1∶2,n=42)and high proportion group(1∶1,n=51).The venous blood of THS patients was collected before blood transfusion and 1 day after blood transfusion,and the coagulation function indexes of THS patients were detected by blood coagulation instrument.The Hb and pH levels in patients were detected by Danish RADIOMETER ABL9 blood gas automatic analyzer,and the usage of blood products,death rate and hospitalization time of all patients were recorded.Results One day after blood transfusion,the prothrombin time(PT)and activated partial thromboplastin time(APTT)of the three groups were significantly higher than those before blood transfusion,and the fibrinogen(FIB)content was significantly lower than that before blood transfusion,with statistically significant differences(P<0.05).One day after blood transfusion,PT and APTT in high proportion group were significantly lower than those in low and medium proportion group,while FIB content was significantly higher than that in low and medium proportion group,with statistically significant differences(P<0.05).The PT and APTT in the medium proportion group were significantly lower than those in the low proportion group one day after blood transfusion,while the FIB content was significantly higher than that in the low proportion group,with statistically significant differences(P<0.05).Within 24 hours of hospitalization,there were no significant differences in the transfused blood products such as suspended red blood cells among low proportion group,medium proportion group and high proportion group(P>0.05).During the hospitalization,the total amount of red blood cell infusion in high proportion group was significantly lower than that in other low and medium proportion groups,with statistically significant difference(P<0.05).There were no significant differences in Hb content and pH among the three groups before blood transfusion and 24 hours after blood transfusion(P>0.05).There were no significant differences in hospitalization and mortality among low proportion group,medium proportion group and high proportion group(P>0.05).Conclusion In the treatment of THS patients,compared with low proportion of plasma and suspended red blood cells,proper infusion ratio can significantly reduce PT and APPT,and increase FIB content,thus improving the coagulation function of patients.