整形外科围手术期大量输血患者的临床特点

Clinical features of patients with massive transfusion during plastic surgery

目的探讨整形外科需要大量输血患者的临床特点。方法对空军军医大学西京医院整形外科需要大量输血患者的围手术期处理进行分析，包括大量输血原因，输注血液制品种类和剂量，以及病情变化等。结果10例患者均以急性失血为主，2例在人院时处于失血性休克状态。其中2例在大量输血过程中出现凝血功能障碍，经治疗后恢复正常。输注成分按占总量百分比计算，分别为输注悬浮红细胞占58．3％，新鲜冰冻血浆占38．6％。10例经过大量输血后，低血容量均得到纠正，凝血功能恢复正常，无重要组织脏器功能损害。结论制定围手术期输血计划对于保障大量输血患者的生命安全及促进康复具有重要意义。

Objective To review the clinical features of the patients received massive transfusion （MT） in plastic surgery department. Methods Ten cases were reviewed. The reason of massive transfusion, the type and dosage of transfusion, the reaction of patients were included. For all the patients, consultation of related department preoperatively was necessary. Based on the through and detailed analysis of the patients＂ condition, necessary blood product should be prepared ahead of operation. During the therapy, adjustment of treatment plan was made from time to time, according to the patient＇s condition. Therefore efficient and prompt therapeutic result was achieved. Results In all the 10 MT cases suffered from acute blood loss, 2 of them were in hemorrhagic shock before administration. Coagulation disorders happened in 2 patients, and recovered after appropriate treatment. RBC, which was 58.3% of total amount of transfusion, used most commonly; the second was fresh frozen plasma （FFP）, which was 38.6% according to the total amount. All the patients had satisfactory recovery, without hemolysis or any other functional disorder. Conclusions For MT patients in the Department of Plastic Surgery, the main proposes are to restore and maintain an effective circulatory blood volume, while preventing the coagulation disorder. Also, detailed analysis, through consultation and timely adjustment are of great importance for the MT patients. It is also the essential of an effective perioperative management.