新鲜冷冻血浆与红细胞1∶1输注对产后出血大量输血患者凝血四项指标变化影响

Effect of fresh frozen plasma and red blood cell 1∶1 infusion on four coagulation indexes in postpartum hemorrhage patients undergoing massive blood transfusion

目的大量输血为挽救产后出血患者主要方式,新鲜冷冻血浆与红细胞输注比例不同对凝血功能影响也不同,目前医学界研究热点主要集中在1∶1输注方面。本研究探讨新鲜冷冻血浆与红细胞1∶1输注对产后出血大量输血患者凝血四项指标变化的影响。方法选取2017-03-01-2019-06-30滑县人民医院收治的产后出血大量输血患者96例,按所用血浆与红细胞比例不同分低比例组(n=32)、中比例组(n=32)和高比例组(n=32)。低比例组予以新鲜冷冻血浆与红细胞1∶2.5输注,中比例组予以新鲜冷冻血浆与红细胞1∶1输注,高比例组予以新鲜冷冻血浆与红细胞1.5∶1输注。对比3组血液制品输入量及输注前、输注后凝血四项[凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)及纤维蛋白原(fibrinogen,FIB)]指标变化,分析输血并发症与凝血四项变化幅度Δ、血液制品输入量关系。结果3组冷沉淀、红细胞、血浆及血小板输注量对比,差异无统计学意义,均P>0.05。输注后3组PT、APTT和TT升高,FIB降低,但中比例组变化幅度较低比例组、高比例组小,均P<0.05。低比例组输血并发症发生率为40.63%(13/32),高于高比例组的18.75%(6/62),高比例组高于中比例组的3.13%(1/32),χ2=13.768,P<0.001。Spearman分析结果显示,输血并发症发生率与PT(r=0.654,P=0.005)、APTT(r=0.701,P<0.001)、TT(r=0.678,P=0.001)和FIB(r=0.594,P=0.012)变化幅度呈正相关。结论应用新鲜冷冻血浆与红细胞1∶1输注能减少对凝血四项指标的影响,确保输血安全。

OBJECTIVE Large amount of blood transfusion is the main way to save postpartum hemorrhage patients.Different proportions of fresh frozen plasma and red blood cell transfusion have different effects on coagulation function.At present,the focus of medical research is mainly focused on 1∶1 transfusion.This study discusses the influence of fresh frozen plasma and red blood cell transfusion on the four coagulation indexes of postpartum hemorrhage patients with large amount of blood transfusion.METHODS A total of 96 patients with postpartum hemorrhage in Huaxian People’s Hospital from March 1,2017 to June 30,2019 were divided into low proportion group(n=32),medium proportion group(n=32)and high proportion group(n=32)according to the proportion of plasma and red blood cells.Fresh frozen plasma and red blood cells were infused 1∶2.5 in the low proportion group,1∶1 in the middle proportion group and 1.5∶1 in the high proportion group.The changes of blood product input and coagulation indexes before and after transfusion were compared in three groups,including prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB).The relationship between blood transfusion complications and four changes of coagulation,blood product input were analyzed.RESULTS There was no significant difference between the three groups in cold precipitation,red blood cell,plasma and platelet transfusion volume(all P>0.05).After infusion,levels of PT,APTT,TT increased and FIB decreased in the three groups,but the change range in the middle proportion group was smaller than that in the low proportion group and the high proportion group(P<0.05).The incidence of blood transfusion complications was 40.63%(13/32)in the low proportion group,18.75%(6/62)in the high proportion group and 3.13%(1/32)in the high proportion group,χ~2=13.768,P<0.001.Spearman analysis showed that the incidence of blood transfusion complications was positively correlated with PT(r=0.654,P=0.005),APTT(r=0.701,P<0.001),TT(r=0.678,P=0.001)and FIB(r=0.594,P=0.012).CONCLUSION The application of fresh frozen plasma and red blood cell 1∶1 infusion can reduce the influence on four coagulation indexes and ensure the safety of blood transfusion.