创伤性失血患者大量输血前后凝血功能与血液指标变化分析

Analysis of change of blood coagulation function and blood index after blood transfusion of traumatic hemorrhage

目的探讨创伤性失血患者大量输注不同比例的悬浮红细胞和冰冻血浆后血液指标的变化,及时为临床治疗提供依据。方法选择平顶山市平煤神马医疗集团总医院2013年1月—2015年6月,因创伤性出血导致的需输注悬浮红细胞大于10 U的患者89例,入院24 h内输注悬浮红细胞:血浆(1∶1)的设为A组,悬浮红细胞:血浆(1.5∶1)设为B组,悬浮红细胞∶血浆(2∶1)设为C组,测定每组患者输血前后凝血功能和血小板计数(Plt)、血红蛋白(Hb)及红细胞压积(Hct)的变化。结果观察3组患者大量输血后PT、APTT、时间较大量输血前明显延长,FIB值明显降低,患者大量输血前后检测数据比较,差异具有统计学意义(P<0.05);不同输注比例患者HGB和Hct较大量输血前明显改善,但所有患者的PLT呈现下降趋势输血前后检测数据比较,差异具有统计学意义(P<0.05)。输血后A、B组凝血功能和血常规均显著优于C组。结论创伤性失血患者大量输血虽是救治创伤患者的重要手段,但同时可能会使患者凝血功能发生紊乱。因此需严密监测凝血功能及血液指标的变化情况,以便及时补充冷沉淀、血小板血液成分,降低或避免因血小板和凝血功能异常引起的出血风险提高输血疗效,对指导临床输血有积极意义。

Objective To investigate the changes of blood indexes of suspended red blood cells and frozen blood in patients with traumatic hemorrhage,and provide the basis for clinical treatment in time. Methods Totally 89 patients with U were selected from January 2013 to June 2015,24 patients with h were selected. The plasma（ 1∶1） was set to A group,and the plasma（ 1∶1） was C group. The changes of coagulation function and platelet count（ Plt）,hemoglobin（ Hb） and red blood cell volume（ Hct） were measured. Results The PT,APTT and time of the three groups were significantly prolonged,the FIB value was significantly decreased,the difference was statistically significant（ P 0. 05）,and the HGB and Hct in patients with and PLT were significantly improved compared with before and after blood transfusion,the difference was statistically significant（ P 0. 05）. A,B group after blood transfusion and blood coagulation function were significantly better than that of C group. Conclusion A large number of blood transfusion in patients with traumatic hemorrhage is an important method to treat patients with trauma,but it may cause the disorder of blood coagulation function. Therefore,it is necessary to closely monitor the changes of blood coagulation function and blood indexes,so as to supplement the cold precipitation,platelet and blood composition,reduce or avoid the risk of bleeding caused by abnormal blood platelet and coagulation function,improve the efficacy of blood transfusion.