大量输注悬浮红细胞对手术患者凝血功能的影响

The effect of large amount of suspended red blood cell transfusion on blood coagulation function in patients with surgery

目的：分析大量输注悬浮红细胞以及新鲜血浆与红细胞不同输注比例对手术患者凝血功能的影响。方法选择东莞市第五人民医院2014年1月～2015年12月大量输血的手术患者85例，根据输注悬浮红细胞的量分为观察组和对照组，根据输注的血浆与悬浮红细胞的比例分为高比例组（≥1∶1）、中比例组（1∶1～1∶2）、低比例组（≤1∶2）。采集静脉血，比较输血前后血红蛋白（HGB）、血细胞比容（HCT）以及凝血相关指标变化情况。其中凝血相关指标包括血小板（PLT）、纤维蛋白原（FIB）、凝血酶原时间（PT）、凝血酶时间（TT）以及活化部分凝血活酶时间（APTT）。结果输血后，所有患者的HGB和HCT均有显著升高，PT、TT和APTT均有显著延长，观察组患者的PLT和FIB均有显著下降，差异具有统计学意义（P均＜0.05）。中比例组和低比例组的PLT和FIB均有显著下降，PT、TT和APTT均有显著延长，且低比例组的变化更明显，差异均具有统计学意义（P均＜0.05）。结论大量输注悬浮红细胞可导致手术患者发生凝血功能障碍，提高血浆与悬浮红细胞的输注比例可减轻凝血功能障碍。

Objective To analyze the effects of large amount of suspended red blood cell transfusion and different injection rates between fresh plasma （FP） and red blood cell on blood coagulation function in patients with surgery. Methods 85 massive transfusion surgical patients from January 2014 to December 2015 in the fifth people＇＇s hospital of Dongguan city were divided into observation group and control group according to the amount of suspended red blood cell transfusion. According to the ratios of plasma and suspended red blood cell transfusion, the patients were divided into high ratio group （≥1∶ 1）,middle ratio group （1∶1-1∶2） and low ratio group （≤1∶2）. Collecting venous blood, the hemoglobin （HGB）, hematocrit （HCT） and coagulation related indicators’ changes of the before and after blood transfusion were compared. The coagulation related indicators contained platelet （PLT）, fibrinogen （FIB）, prothrombin time （PT）, thrombin time （TT） and activated partial thromboplastin time （APTT）. ResultsAfter blood transfusion of all the patients, the HGB and HCT levels were significantly increased, and the PT, TT and APTT values were dramatically prolonged. The PLT and FIB of the observation group were significantly decreased, the differences were statistically significant （allP〈0.05）. In the middle and low ratio group, the PLT and FIB levels were significantly decreased, while the PT, TT and APTT values were dramatically prolonged. The levels’ changes of the low ratio group were more apparent. All the differences were statistically significant （allP〈0.05）. Conclusion Large amount of suspended red blood cell transfusion could lead to coagulation dysfunction in surgical patients. Increasing the ratios of plasma and suspended red blood cell transfusion could relieve the coagulation dysfunction.