凝血酶原复合物与新鲜冰冻血浆治疗围术期稀释性凝血功能障碍效果比较

Comparison of prothrombin complex and fresh frozen plasma in treatment of perioperative dilutional coagulation disorder

目的比较凝血酶原复合物(PCC)与新鲜冰冻血浆(FFP)治疗围术期稀释性凝血功能障碍(DCP)时,对患者凝血功能和血液流变学指标的影响。方法选取行骨科手术且术中发生DCP的患者49例,其中术中补充PCC治疗24例(PCC组),FFP治疗25例(FFP组)。观察并比较两组患者治疗前后凝血功能指标PT、APTT、TT、血液流变学指标[全血高切黏度(HBV)、全血低切黏度(LBV)、血浆黏度(PV)、纤维蛋白原(FIB)]及不良反应发生情况。结果治疗前,两组患者PT、APTT、TT及血液流变学指标比较均无统计学差异(均P>0.05)。治疗后,两组PT、APTT、TT均较治疗前缩短(均P<0.05),组间比较均无统计学差异(均P>0.05)。治疗后,PCC组HBV、LBV、PV及FIB均较FFP组降低(均P<0.05)。FFP组出现轻微输血反应1例,PCC组未出现不良反应。结论PCC与FFP均能在一定程度上改善DCP患者凝血功能;在血液流变学方面,PCC与FFP相比,可明显降低血液黏滞度。

Objective To compare the efficacy of prothrombin complex(PCC)and fresh frozen plasma(FFP)in treatment of perioperative dilutional coagulation disorder(DCP).Methods 49 patients with DCP during orthopedic surgery were recruited,including 24 cases were treated with PCC(PCC group)and 25 were treated with FFP(FFP group).The coagulation function indexes prothrombin time(PT),activated partial thromboplastin time(APTT)and blood enzyme time(TT);hemorheological indexes whole blood high shear viscosity(HBV),whole blood low shear viscosity(LBV),plasma viscosity(PV)and fibrinogen(FIB)were measured;the adverse reactions were observed and compared between the two groups before and after treatment.Results Before treatment,there was no significant difference in PT,APTT,TT and hemorheology between the two groups(all P>0.05).After treatment,PT,APTT and TT were shorter than those before treatment in both groups(all P<0.05),while there were no significant differences between the two groups(all P>0.05).After treatment,HBV,LBV,PV and FIB in PCC group were lower than those in FFP group(all P<0.05).There was 1 case of mild transfusion reaction in FFP group and no adverse reaction in PCC group.Conclusion PCC and FFP can improve coagulation function in DCP patients to some extent,and PCC can significantly reduce blood viscosity compared with FFP.