新鲜冰冻血浆临床输注回顾性调查分析

Clinical use of fresh frozen plasma:a retrospective analysis in 3 Class-AAA hospitals

目的调查分析新鲜冰冻血浆(fresh frozen plasma,FFP)临床资料,了解FFP临床输血情况。方法查阅2009年1-12月四川省人民医院、成都军区总医院及第三军医大学新桥医院接受FFP输血患者的病历,对输浆总量、人均输浆量、不同科室用浆情况、标准凝血试验检测情况等进行调查分析。结果本调查包括2 036例患者、5 570例次输注,共输FFP 21 062.9 U。49.1%患者仅接受1次FFP输血,14.5%患者接受普通冰冻血浆(FP)、FFP输注总量≤2 U。每例次输注量手术科室与非手术科室比较差异有统计学意义(P<0.05)。FFP用量最多的3个科室为胸外科、消化科及骨科。191例患者(9.4%)未检测凝血酶原时间(prothrombin time,PT),224例患者(11.0%)未检测活化部分凝血活酶时间(acti-vated partial thromboplastin time,APTT)。PT≥50 s的患者接受FFP输血后PT值缩短较为明显;FFP输血对APTT检测值影响较小。结论临床输血存在血浆用量不足现象,不同科室FFP用量不同,FFP输血对PT、APTT明显延长患者有一定治疗作用。

Objective To investigate the clinical data of fresh frozen plasma （FFP） transfusions in 3 Class-AAA hospitals in order to grasp clinical transfusion. Methods We investigated and analyzed medical re- cords of patients who had received FFP transfusions in Sichuan Provincial People＇ s Hospital, Xinqiao Hospital, and General Hospital of Chengdu Military Command during January to December 2009. Indexes included total volume of FFP, average volume, situations of using FFP in different departments and the standard coagulation tests in these patients. Results In this investigation, 5 570 FFP transfusions were given to 2 036 patients, with a total volume of 21 062.9 U. Among these patients, 49.1% of them had received FFP transfusion only once, and 14.5% had received no more than 2 U plasma. There was a significant difference in average doses of each FFP transfusion between surgical departments and non-surgical departments （ P 〈 0. 05 ）. Patients from departments of thoracic surgery, gastroenterology and orthopedics received more FFP than patients in other departments. There were 191 patients （9.4%） getting FFP transfusions in absence of prothrombin time （PT） records, and 224 patients （11.0%） without activated partial thromboplastin time （APTr） records. The median reductions in PT were shorter when the baseline pre-FFP transfusion PT was longer than 50 s. FFP had little effect on APTF. Conclusion Some clinical use of plasma is not adequate. There is a significant difference in FFP doses of transfusions among different departments. FFP transfusion exerts therapeutic effect on the patients with prolonged PT or APTT.