不同血浆和红细胞比例输注对胃肠道肿瘤围术期大量输血患者的影响

Effect of Different Proportions of Plasma and Red Blood Cell Transfusion on Gastrointestinal Cancer Patients with Massive Perioperative Blood Transfusion

目的探讨不同血浆和红细胞比例输注对胃肠道肿瘤围术期大量输血患者的影响。方法回顾性分析2011年3月至2013年3月在新疆医科大学第一附属医院胃肠科因手术需要大量输血的91例胃肠道肿瘤患者的临床资料,根据患者在治疗过程中输注的血浆和红细胞比例的高低分为高比例组15例,中比例组32例,低比例组44例。比较三组患者输注24 h后的血常规、凝血功能指标,患者预后情况,血液制品的输注总量。结果三组患者输注前后血红蛋白在比较差异无统计学意义(P>0.05);血小板(PLT)计数,与输注前相比,输注后中比例组和低比例组均显著降低(P<0.05),低比例组输注后PLT显著低于高比例组和中比例组[(65.2±36.2)×10~9/L比(94.2±53.4)×10~9/L、(92.5±40.3)×10~9/L](P<0.05)。输注后高比例组和低比例组凝血酶原时间均较输注前显著延长(P<0.05),中比例组显著低于高比例组和低比例组[(15.2±5.3)s比(21.5±9.2)s,(20.4±10.3)s,P<0.05];输注后低比例组活化部分凝血活酶时间较输注前显著升高(P<0.05),低比例组显著低于高比例组、中比例组[(50.6±9.2)s比(37.5±10.5)s、(42.6±10.1)s,P<0.05];输注后低比例组国际标准化比值较输注前显著升高,低比例组显著低于高比例组和中比例组[(1.66±0.51)s比(1.10±0.16)s,(1.23±0.16)s,P<0.05]。三组患者的住院时间、ICU时间、病死率比较差异无统计学意义(P>0.05)。三组患者的红细胞输注量、血小板输注量以及冷沉淀的输注量比较差异均无统计学意义(P>0.05),高比例组血浆的输注量显著高于中比例组、低比例组[(2 544±651)m L比(1 395±432)m L、(310±29)m L,P<0.05],中比例组显著低比例组(P<0.05)。结论对于胃肠道肿瘤围术期大量输血患者按照中比例输注,不仅可以有效降低患者输注血液成分的总量,而且可以有效缓解患者凝血功能障碍,而且对预后无显著影响。

Objective To evaluate the effect of different proportions of plasma and red blood cell transfusion on gastrointestinal cancer patients with massive perioperative blood transfusion. Methods Retrospective analysis of 91 gastrointestinal cancer patients with massive blood transfusion during the perioperative period from Mar. 2011 to Mar. 2013 in the First Affiliated Hospital of Xinjiang Medical University was done,the patients were divided into a high proportion group with 15 cases, a middle proportion group with 32 cases, and a low proportion group with 44 cases according to the plasma and red cell infusion proportions. The blood routine, blood coagulation index, prognosis of patients with total transfusion of blood products after 24 h of infusion of the three groups were compared. Results There was no significant difference in the Hb level between the three groups before and after infusion （P 〉 0. 05 ） ; as for the count of PLT, compared with before infusion, the middle proportion group and low proportion group were significantly decreased after infusion（ P 〈 0. 05 ）, the low proportion group was significantly lower than that in the high proportion group and middle proportion group after the infusion [（65.2 ± 36. 2） ×10^9/L vs （94. 2 ± 53.4）×10^9/L, （92. 5 ± 40. 3 ）×10^9/L, P 〈 0. 05 ] ; PT time of the high proportion group and low proportion group were signifieanfly prolonged after infusion （ P 〈 0. 05 ）, the middle proportion group significantly lower than the high proportion group and low proportion group [ （ 15.2 ± 5.3 ） s vs （ 21.5 ± 9.2 ） s, （ 20. 4± 10. 3） s,P 〈0. 05] ;APTT time in the low proportion group significantly increased after infusion（P 〈0. 05） ,and the low proportion group was significantly lower than that of the high proportion and the middle proportion group [（50. 6 ±9. 2 ） s vs （37. 5 ± 10. 5 ） s, （42. 6± 10. 1 ） s, P 〈 0.05] ; the ratio of INR in the low proportion group increased significantly after infusion, the low proportion group was significantly lower than that of the high proportiofi group and the middle proportion group [ （ 1.66 ± 0. 51 ） vs （ 1.10 ± 0. 16 ）, （ 1.23 ±0. 16 ）, P 〈 0. 05 ] ; there was no statistically significant difference in hospitalization time ,ICU time, and death ratio between the three groups （P 〉 0. 05 ）. There was no statistically significant difference in erythrocyte transfusion and platelet transfusion and infusion of cryoprecipitate volume in the three groups of patients. The plasma infusion amount in the high proportion group was significantly higher than that in the middle proportion group and low proportion group [（2 544 ± 651 ） mL vs （1 395 ± 432） mL, （310± 29 ） mL, P 〈 0. 05 ], the middle proportion group significantly lower than the low proportion group（P 〈 0. 05 ）. Conclusion For the patients with gastrointestinal tumor needing perioperative massive transfusion, the middle proportion of infusion not only can effectively reduce the total amount of blood components infusion, but also can effectively alleviate the patient＇s coagulation disorders, with no significant impact on the prognosis.