严重创伤失血性休克大剂量输血的并发症及防治对策

The complications and treatment of massive blood transfusion in severe trauma patients with hemorrhagic shock

目的探讨严重创伤失血性休克大剂量输血的并发症,并提出防治对策。方法回顾性分析1997年8月到2006年8月本科收治的24例严重创伤失血性休克大剂量输血患者的临床资料。本组输血量4 200 ml-10 000 ml16例,10 000 ml-12 800 ml 8例;输血成分为红细胞、新鲜冰冻血浆、浓缩血小板、新鲜全血。4种成分血均输的有4例,输前3种的有4例,输前2种的有16例。结果本组10例并发凝血功能障碍:上消化道出血伴皮肤紫斑?下消化道出血各2例,出现早期DIC3例,出现典型DIC3例。本组生存19例,死亡5例。直接死于创伤失血性休克2例,典型DIC 3例均死亡。并发代谢性酸中毒8例,低钠低氯1例无低血钾,低血钙2例但未出现抽搐,无代碱。结论大剂量输血可以引起凝血功能障碍,水电解质酸碱平衡紊乱,低体温等并发症。提高麻醉和手术技能,减少出血;避免不合理输血;提倡成分输血;建立早期DIC的概念有望提高治愈率。

Objective To explore the complications and treatment of massive blood transfusion in severe trauma patients with hemorrhagic shock and pose prophylactico-therapeutic measures. Methods Clinical materials of 24 cases with severe trauma complicated with hemorrhagic shock who were treated with massive blood transfusion from August 1997 to August 2006 in our department of emergency surgery were retrospectively analyzed. The volume of blood transfusion was from 4200 ml to 12800 ml. The volume of blood transfusion was from 4200 ml to 10000 ml in 16 cases and from 10000 ml to 12800 ml in 8 cases. All patients were transfused with the component blood transfusion, such as erythrocytes, plasma, thrombocytes and so on. Results Of all 24 cases, 10 cases were complicated with blood coagulation disfunction：2 cases with upper gastrointestinal hemorrhage, 2 cases with lower gastrointestinal hemorrhage ,3 cases with early DIC and 3 cases with typical DIC. 19 cases survived and 5 cases died in this group. 2 cases died from hemorrhagic shock 2 and 3 cases from typical DIC. 8 cases were complicated with metabolic acidosis, 1 case with hyponatremia and 2 cases with hypocalcium. Conclusion Massive blood transfusion can lead to the complications such as blood coagulation dysfunction, water-lectrolyte and acid-base disturbances, hypothermia and so on. These measures which includes improving the skill of operation and anesthesia, component blood transfusion, rational blood transfusion and predicting early state of DIC are helpful to improving curative rate.