输注不同比例血浆和红细胞对凝血功能障碍及的影响

Effect of Infusion of Different Ratios of Plasma and Red Blood Cells Suspension on Coagulation Dysfunction

目的探讨输注不同比例血浆和红细胞对凝血功能障碍:方法选取2014年7月至2016年9月我院大量输血患者90例为研究对象,按入院24 h内输注新鲜冻血浆(FFP)与红细胞悬液(RBCs)比例将其分为低比例组(D1组,FFP:RBCs为1:3)、中比例组(D2组,FFP:RBCs为1:2)、高比例组(D3组,FFP:RBCs为1:1),均30例,记录三组住院时间、入住ICU时间、治愈率及病死率,比较三组血液制品输注量及大量输血前后凝血功能指标、血常规指标变化。结果三组住院时间、入住ICU时间、治愈率及病死率比较无显著差异(P>0.05);D3组FFP用量(2.60±1.57)L明显高于D1组、D2组,而三组RBCs、血小板、冷沉淀使用量比较无显著差异(P>0.05);大量输血后,三组活化部分凝血酶原时间(a PTT)、凝血酶原时间(PT)均延长,但D1组>D2组>D3组,三组纤维蛋白原(Fbg)均下降,但D3组Fbg(2.10±0.56)g/L高于D1组、D2组(P均<0.05)。结论对大量输血患者,将血浆和红细胞按1:1比例输注有利于预防凝血功能障碍。

Objective To investigate the effect of infusion of different ratios of plasma and red blood cells on coagulation dysfunction. Methods From July 2014 to September 2016,90 patients with massive blood transfusion in the hospital were selected as the study subjects. According to the ratio of infused fresh frozen plasma（FFP）and red cell suspension（ RBCs）, the subjects were divided into the low ratio group（ D1 group, FFP ： RBCs 1：3 ）, middle ratio group （ D2 group, FFP： RBCs 1：2 ） and high ratio group （ D3 group, FFP： RBCs, 1：1 ） ,30 cases in each group. The length of hospital stay, length of ICU stay, cure rates and mortality rates were recorded. The infused volume of blood products, changes of coagulation indexes and blood routine indexes before and after massive b!ood transfusion were compared among the three groups. Results The length of hospital stay, length of ICU stay, cure rates and mortality rates showed no significant differences among the three groups （P 〉 0.05 ）. The dosage of FFP （ 2.60 ± 1.57 ） L in D3 group was significantly more than D1 group and D2 group while there were no significant differences in RBCs, platelet and application amount of cryoprecipitate （ P 〉 0. 05 ）. After massive blood transfusion, the activated partial thromboplastin time （aFIT）and prothrombin time（PT） of all groups were prolonged, showing D1 group 〉 D2 group 〉 D3 group. The levels of fibrinogen（Fbg）were decreased, and the Fbg level（2. 10 ± 0.56）g/L in D3 group was higher than D1 group and D2 group （P 〈 0. 05 ）. Conclusion For patients with massive blood transfusion, the infusion in proportion to 1：1 of FFP：RBCs is helpful to prevent coagulation dysfunction.