新鲜冰冻血浆输注对创伤大失血患者凝血功能的影响

Impact of massive infusion of different proportions of fresh frozen plasma on blood coagulation function in trauma patients with loss of blood

目的:探讨不同比例新鲜冰冻血浆(FFP)大量输注对创伤大失血患者凝血功能的影响。方法:选择进行输血治疗的146例严重创伤大失血患者为研究对象。根据患者大失血4h内输注的FFP和悬浮红细胞(SRBC)的比例进行分组。FFP∶SRBC=1∶3为低FFP组,51例;FFP∶SRBC=1∶2为中FFP组,46例;FFP∶SRBC=1∶1为高FFP组,49例。比较3组患者输血后24h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及血小板计数(PLT)等指标恢复情况。结果:13组患者输血前在年龄、体质量、创伤严重程度评分及体温、呼吸、脉搏、收缩压、舒张压等主要生命体征指标上比较,差异无统计学意义(P>0.05);23组间输血前PT、APTT、TT、FIB、PLT等指标间差异比较无统计学意义(P>0.05);组内输血后24hPT、APTT、TT、FIB、PLT等指标与输血前比较,差异有统计学意义(P<0.05);输血后24h中FFP组和高FFP组PT、APTT、TT、FIB、PLT等指标恢复情况好于低比例组,差异有统计学意义(P<0.05)。结论:较高比例的FFP输注能在一定程度上改善大量输血患者的凝血功能,减少不必要的出血,提高输血的疗效和安全性。

Objective：To discuss the impact of massive infusion of different proportions of fresh frozen plasma on blood coagulation function in trauma patients with loss of blood.Method：146cases of trauma patients with loss of blood for blood transfusion therapy were chosen as research objects.The patients were divided into three groups according the ratio of fresh frozen plasma（FFP）to suspended red blood cells（SRBC）in 4hof massive loss of blood,which were low FFP group（FFP∶SRBC=1∶3,n=51）,middle FFP group（FFP∶SRBC=1∶2,n=46）,and high FFP group（FFP∶SRBC=1∶1,n=49）.PT,APTT,TT,FIB and PLT at 24 hafter blood transfusion were compared in three groups.Result：①Age,body mass,injury severity score and body temperature,respiration,pulse,the systolic pressure,diastolic blood pressure and other main vital indicators before blood transfusion were compared in three groups,and there was no statistically significant difference（P〉0.05）.②The differences of PT,APTT,TT,FIB and PLT before blood transfusion in three groups was no statistical significance（P〉0.05）.PT,APTT,TT,FIB and PLT at 24 hafter blood transfusion within the same group were compared,and the difference were statistically significant（P〈0.05）.PT,APTT,TT,FIB and PLT at 24 hafter blood transfusion in middle FFP group and high FFP group were better than those in low FFP group,and the difference were statistically significant（P〈0.05）.Conclusion：High proportion of FFP infusion could improve blood coagulation function in trauma patients with loss of blood for massive blood transfusion,and reduce unnecessary bleeding,elevate the curative effect and security of blood transfusion.