2005年与2010年大量输血患者临床用血对比分析

Comparative analysis of clinical blood usage in patients receiving massive blood transfusion between 2005 and 2010

目的为制定大量输血患者合理成分输血的治疗方案提供依据。方法回顾2005年和2010年大量输血患者各种血液成分输注情况,分析不同性别、血型、治疗结果的患者人均红细胞输用量,计算不同科室患者各血液成分搭配输注比例,比较输血后患者凝血功能变化。结果 2010年较2005年总用血量增加,主要为血浆用量增加,红细胞用量减少;女性患者、AB血型患者人均红细胞用量低于男性患者和其他血型患者,死亡患者明显高于治愈患者,两年统计结果一致;不同科室选择各种血液成分应用比例不同,2005年红细胞∶血浆比例为7.9∶1.0,患者死亡率为21.62%,比2010年(红细胞∶血浆比例为2.1∶1.0,患者死亡率为4.44%)明显增高(χ2=4.9,P<0.05);输血后患者凝血功能检测2005年凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血时间(APTT)比2010年明显延长,纤维蛋白原(Fg)降低(P<0.05)。结论大量输血时根据病情制定合理输血方案,选择有效血液成分,可减少大量输血并发症的发生,提高抢救成功率。

Objective To provide evidence for formulating treatment protocols of reasonable component blood transfusion for patients receiving massive blood transfusion.Methods Component blood transfusion in patients receiving massive blood transfusion in 2005 and 2010 were retrospectively analyzed,including the average amount of red cell suspension in patients with different sex,blood type and treatment outcome.Component blood transfusion proportion of different departments was calculated.Blood coagulation function of patients before and after blood transfusion was compared.Results The total amount of blood transfusion was increased in 2010 than in 2005,with increasing of the amount of plasma and reducing of the amount of red cell suspension.The average amount of red cell suspension transfusion in female patients,patients with AB blood type and dead patients was higher than in male patients,patients with other blood types and cured patients.There were no significant differences between the two years.There were different component blood transfusion proportions of different departments.The proportion of red cell suspension versus plasma was 7.9：1.0,and the mortality was 21.62% in 2005,both of which were higher than 2.1：1.0 and 4.44% in 2010（χ^2=4.9,P〈0.05）.After blood transfusion,prothrombin time（PT）,thrombin time（TT）and activated partial thromboplastin time（APTT） were extended and fibrinogen（Fg） was reduced in 2005,compared with 2010.Conclusion Reasonable protocols transfusion should be formulated and effective component blood transfusion should be selected for patients receiving massive blood transfusion to reduce complications and improve the successful rescue rate.