围术期血浆与红细胞不同输注比例对大量输血患者预后的影响

Effect of perioperative different ratios of fresh frozen plasma to red blood cell on prognosis of patients receiving massive transfusion

目的回顾性分析围术期输注不同比例血浆和红细胞（RBC）对大量输血患者预后的影响。方法选择2010年1月-2012年9月24h内输注RBC≥10U手术患者139例，根据围术期输注新鲜冰冻血浆（FFP）与RBC的比例，将患者分为三组：高比例组（FFP：RBC〉1：1）19例、中比例组（FFP：RBC=1：2～1：1）43例、低比例组（FFP：RBC〈1：2）77例。比较三组住院期间血制品输注情况以及大量输血前后血常规指标、凝血功能指标、电解质指标、住院时间、住ICU时间、治愈率及病死率的差异。结果（1）FFP输注量高比例组最多为（2600±1582）ml，中比例组较多为（1390±1043）m1，低比例组最少为（318±342）ml（P〈0．05）；血小板（PLT）输注量高比例组（0～1．4U）和中比例组（0～1．0U）均较低比例组多（0～0．0U）（P〈0．05）；三组在RBC和冷沉淀输注量上差异均无统计学意义。（2）输血前，中比例组凝血酶原时间（胛）、活化部分凝血活酶时间（APTT）[（20．2±10．7）S、（57．2±45．8）s]较高比例组和低比例组均明显延长[（14．3±4．4）s、（35．3±10．0）s和（12．5±1．7）S、（31．5±5．9）S]（P〈0．05），三组血红蛋白（Hb）、PLT、国际标准化比值（1NR）、K^＋及Ca^2＋浓度差异均无统计学意义；输血后，低比例组Hb为（106．8±31．7）g／L，较中比例组和高比例组高[（82．5±32．2）g/L、（91．3±19．1）g／L]（P〈0．05），低比例组Ca^2＋浓度为（1．99±0．24）mmol／L，较中比例组和高比例组高[（1．76±0．38）mmol／L、（1．96±0．25）mmoL／L]（P〈0．05），三组PTJT、PT、INR、APTT及K^＋浓度差异均无统计学意义。（3）三组住院时间、住ICU时间、治愈率及病死率差异均无统计学意义。结论对于大量输血患者，按FFP：RBC=1：2—1：1输注，将有利于预防大量输血患者发生凝血功能障碍，减少患者住院期间血浆输注总量，对预后无影响。

Objective To retrospectively analyze the influence of perioperatively transfusing different ratios of fresh frozen plasma （FFP） to red blood cell （ RBC ） on prognosis of patients receiving massive transfusion. Methods From January 2010 to September 2012, 139 surgical patients with transfusion of ≥10 RBC units within 24 hours were included in the study. Patients were categorised into three groups based on the FFP： RBC scale： high scale group （FFP： RBC 〉 1 ： 1, n = 19） , middle scale group （ FFP ： RBC = 1 ： 2-1 ： 1, n = 43 ） and low scale group （ FFP ： RBC 〈 1 ： 2, n = 77 ）. Comparison among the groups was made in aspects of transfusion of different blood products in hospital, blood routine index before and after massive transfusion, blood coagulation index, electrolyte index, hospital stay, ICU stay, cure rate and mortality. Results FFP transfusion was the most in high scale group （2 600 ± 1 582） ml, followed by （ 1 390 ± 1 043 ） ml in middle scale group and （ 318 ± 342） ml in low scale group （P 〈0. 05 ）. Platelet （PLT） transfusion was more in high scale group （0-1.4 units） and middle scale group （0-1.0 units） compared with that in low scale group （0-0.0 units, P 〈0. 05）. Volume of RBC and cryoprecipitate transfused revealed no significant differences among the groups （ P 〉 0.05 ）. Before blood transfusion prothrombin time （PT） [ （20.2 ± 10.7） s J and activated partial thromboplastin time （AFFF） [ （57.2 ± 45.8 ）s ] in middle scale group were significantly prolonged than those in high scale group [ （ 14.3± 4.4） s and （35.3 ± 10. 0） s ] and low scale group [ （ 12.5± 1.7 ） s and （ 31.5 ±5.9 ） s ] （P 〈0. 05）, but the differences were insignificant in indices of hemoglobin （Hb）, PLT, international normalized ratio （INR）, K ^＋ , and Ca^2＋ （P 〉 0.05 ）. After blood transfusion Hb [ （106.8 ± 31.7） g/L] and Ca^2＋[ （1.99±0. 24）mmol/L] in low scale group were higher than these in middle scale group [ （ 82.5±32.2） g/L and （ 1.76± 0.38 ） mmolfL ] and in high scale group [ （ 91.3 ± 19. 1 ） g/L and （ 1.96 ±0.25） mmol/L] （P 〈0.05）, but there were no significant differences in PLT, PT, INR, APTT and K^＋（P 〉 0. 05 ）. Moreover, hospital stay, ICU stay, cure rate and mortality were not differed significantly among the groups （P 〉 0.05 ）. Conclusion For massive transfusion patients, transfusion of FFP and RBC at a 1 ： 2 to 1 ： 1 ratio is beneficial to preventing coagulation dysfunction and reducing plasma total infusion volume, and exerts no effect on the prognosis.