成分血比例对急性创伤性凝血病预后的影响

Effects of blood product ratio on the prognosis of acute traumatic coagnlopathy patients

目的观察不同比例的成分血输注对急性创伤性凝血病（ATC）患者预后的影响。方法58例ATC患者随机分成按照3：1输注悬浮红细胞（PRBC）和新鲜冰冻血浆（FFP）的对照组和按照1：1输注的试验组。检测每个患者术前及术后前3d的血红蛋白（HB）、凝血酶原时间（胛）、国际化标准比率（INR）、纤维蛋白原（FIB），统计前4d的PRBC用量、机械通气时间和ICU住院时间，比较两组的休克纠正率、并发症发生率、28d伤死率。结果试验组前4d的PRBC用量少于对照组，（21．5±6．6）单位vs（29．2±8．3）单位；机械通气时间和ICU住院时间均短于对照组，分别为（7．9±5．8）dvs（11．3±8．7）d和（10．8±7．5）dvs（17．9±14．3）d；休克纠正率高于对照组，92．9％VS40．0％；并发症发生率和28d伤死率低于对照组，分别为53．6％vs96．7％和21．4％vs50．0％（P均〈0．05）。试验组术后的PT、INR、FIB均优于对照组（P均〈0．05）。结论按照1：1输注PRBC和FFP治疗ATC，不仅能减少PRBC的输注，缩短机械通气时间和ICU住院时间，而且能提高休克纠正率，降低并发症发生率及28d伤死率。

Objective To observe the effects of blood product ratio on the prognosis of acute traumatic coagulopathy（ATC） patients. Methods 58 cases with the diagnosis of ATC were divided randomly into control group with the ratio of 3 packed red blood cells （PRBC） to 1 fresh frozen plasma （FFP） and experimental group with the ratio of 1 PRBC to 1 FFP. Hemoglobin（ HB）, prothrombin time （ PT）, international normalized ratio （INR）, and fibrinogen（FIB） were detected before operation and on the 1,2,3 day after operation; the volume of PRBC on 4 day after admission, time of mechanical ventilation, ICU length of stay were counted;the corrected rate of shock, the rate of complications and the 28 - day mortality were also compared between two groups. Results The volume of PRBC （21.5 ± 6.6） units, mechanical ventilation time （7.9 ± 5.8） days, and length of stay in ICU （ 10.8 ±7.5 ） days in experimental group were less than those in control group [ （29.2 ± 8.3 ） units, （ 11.3 ±8.7 ） days, （ 17.9± 14.3 ） days ] （ all P 〈 0.05 ）. The corrected rate of shock （ 92.9% ） in experimental group was higher than that of control group （40.0%）, while the rate of complications （ 53.6% ）, the 28 - day mortality （21.4%） were lower than those of control group （96.7%, 50.0% ） （ all P 〈 0. 05 ）. The levels of PT, INR and FIB of experimental group after the operation were obviously better than those of control group （all P 〈 0. 05）. Conclusion In patients with ATC, the ratio of 1 PRBC to 1 FFP could not only reduce the volume of PRBC, shorten the mechanical ventilation time and the length of stay in ICU, but also increase the corrected rate of shock, and decrease the rate of complications and the 28 - day mortality.