输血对肝硬化上消化道出血患者再出血的影响

Effects of blood transfusion on rebleeding of cirrhotic patients with upper gastrointestinal bleeding

目的:研究输血对肝硬化上消化道出血患者再出血的影响。方法:选取144例肝硬化上消化道出血患者,按照随机数表法将其分为对照组和观察Ⅰ组、观察Ⅱ组,每组各48例。对照组患者为肝硬化上消化道出血且未进行输血者;观察Ⅰ组患者为肝硬化上消化道出血且输悬浮红细胞者;观察Ⅱ组患者在观察Ⅰ组基础上输入血浆。比较治疗后48 h,3组患者的止血效果。将96例观察Ⅰ组和观察Ⅱ组患者,按照输入悬浮红细胞的量1U、2U及3U不同分为输血一组、输血二组和输血三组,每组各32例。分析给予患者输悬浮红细胞量与再出血量的关系。结果:治疗48 h后,观察Ⅰ组患者再出血率低于对照组和观察Ⅱ组(均P<0.05)。输血三组患者的再出血量均高于输血一组和输血二组(P<0.05),且输入悬浮红细胞量与再出血量存在正相关(r=0.42,P<0.05)。结论:在给予肝硬化上消化道出血患者输血时,单纯补充悬浮红细胞引起继续出血的几率很高,且输悬浮红细胞的量越多,继续出血量越多;而同时输血浆可以给予患者补充凝血因子,可使继续出血几率明显下降。

B Objective： To investigate effects of blood transfusion on rebleeding of cirrhotic patients with upper gastrointestinal bleeding. Methods ： A total of 144 cases of cirrhosis with upper gastrointestinal hemorrhage patients were selected and randomly divided into control group, observation group I and group II according to the random number table method, 48 cases in each group. Those with liver cirrhosis combined with upper gastrointestinal bleeding but no blood transfusion were used as control group, those with liver cirrhosis combined with upper gastrointestinal bleeding and transfusion of suspension of red blood cells were chosen as observation group I, and those with liver cirrhosis combined with upper gastrointestinal bleeding and transfusion of suspension of red blood cells and plasmawere selected as observation group II. 3h after the treatment, the hemostatic effects of the three groups were compared. Accord-ing to the suspension red blood cells amount of 1U, 2U and 3U, the 96 cases in observation group I and group II were then divided into blood transfusion I, II and III groups, 32 cases in each group. Further, the relationship between the amount of suspended red blood cells and the amount of rebleeding was analyzed. Results： 48 h after the treatment, the rebleeding rate of observation group I was lower than those of the control group and the observation group II （ P〈0.05）. The amount of re-bleeding in transfusion group IIIwas higher than those of transfusion group I and II （ P〈0. 05）. There was a positive correlation between the amount of suspended red blood cells and the amount of re-bleeding（r = 0. 42, P〈0. 05 ） . Conclusions： For the cirrhosis and upper gastrointestinal hemorrhage patients, the probability of rebleeding of single red blood cell supplement is higher, and the greater the amount of suspended red blood cells is, the more the bleeding amount is; however, red blood cell supplement combined with plasma transfusion can reduce the bleeding probability significantly.