血浆与红细胞不同输注比例对创伤性失血患者大量输血救治的影响

Effects of different ratios of frozen plasma (FP) to red blood cell (RBC) on the outcome of traumatic hemorrhagic patients after massive transfusion

目的探讨大量输血时,输注不同比例的血浆和红细胞对创伤性失血患者救治的影响。方法回顾性分析本院2008年1月～2011年8月间,因创伤性失血需要输注悬浮红细胞10U以上的患者131例次。根据入院24h内输注血浆与悬浮红细胞(FP∶RBC)的比例,将患者分为高比例组(FP∶RBC≥1∶1,n=56)、中比例组(FP∶RBC=1∶2～1∶1,n=43)、低比例组(FP∶RBC≤1∶2,n=32)。采用单变量方差分析、配对t检验和Kaplan-Meier的统计方法,比较患者大量输血前后和3组之间凝血功能指标、在院期间红细胞输注总量、生存率的差异。结果与输血前相比,高比例组和中比例组患者输血后APTT、PT-INR均无明显变化,低比例组APTT、PT-INR均明显升高(P<0.01)。3组之间输血后的凝血功能指标、在院期间红细胞输注总量差异有统计学意义[输血后APTT,高vs中vs低:(37.3±12.4)vs(41.1±11.5)vs(49.9±14.0),P<0.05;输血后PT-INR,高vs中vs低:(1.11±0.19)vs(1.20±0.37)vs(1.66±0.62),P<0.05;在院期间红细胞输注总量,高vs中vs低:(19.8±6.3)vs(25.8±11.3)vs(26.6±8.0),P<0.01],但生存率差异无统计学意义。输血后高、中比例组凝血功能均显著优于低比例组(P<0.05),高比例组在院期间红细胞输注总量显著少于其他2组,低比例组与中比例组相比无差异。结论大量输血时,较高比例地输注血浆,有利于预防创伤性失血患者发生凝血功能障碍,降低患者住院期间红细胞输注总量,达到节约血液资源的目的。

Objective To investigate the effects of different ratios of frozen plasma（FP） to red blood cell（RBC）（FP∶RBC） on the outcome of hemorrhagic trauma patients after massive transfusion.Methods A retrospective study of 131 cases of massively transfused hemorrhagic trauma patients（≥10 U of RBC in 24 hours） from January 2008 to August 2011 in Daping hospital was carried out.According to the ratio of transfused FP to RBC over the first 24 hours,patients were grouped into high ratio group（FP∶RBC≥1∶1,n=56） ,middle ratio group（FP∶RBC =1∶2～1∶1,n=43） ,and low ratio group（FP∶RBC≤1∶2,n=32） .The statistical methods of simplex variance analysis,paired-samples t test and Kaplan-Meier analysis were applied to analyze the differences in coagulation function indices,total units of RBCs transfused during the hospitalization and survival time.Results Transfusion did not change the values of APTT and PT-INR significantly,in both high and middle ratio group,while in low ratio group APTT and PT-INR increased significantly（P0.01） .Among the three groups,there was significant difference in coagulation function indices after massive transfusion（APTT after transfusion,high vs middle vs low：37.3±12.4 vs 41.1±11.5 vs 49.9±14.0,P0.05;PT-INR after transfusion,high vs middle vs low：1.11±0.19 vs 1.20±0.37 vs 1.66±0.62,P0.05） .The difference of total units of RBCs transfused during hospitalization was significant（high vs middle vs low：19.8±6.3 vs 25.8±11.3 vs 26.6±8.0,P0.001） .There was no significant difference in the survival time among the three groups.In the high ratio group,coagulation function was best and the total RBCs transfused in the hospital the least.Conclusion Massive transfusion with high ratio of FP to RBCs,is associated with better coagulation function and less blood transfusion in hemorrhagic trauma patients.