不同比例悬浮红细胞及新鲜冰冻血浆对创伤大输血患者凝血功能的影响

Effect of different proportion of suspended red blood cells and fresh frozen plasma on coagulation function in patients with traumatic big blood transfusion

目的探讨不同比例悬浮红细胞(SRBC)及新鲜冰冻血浆(FFP)对创伤大输血患者凝血功能的影响。方法选择外伤及手术需一次性输注SRBC>10 U的130例患者作为研究对象,根据FFP和SRBC输注比例不同分为4组,低比例组(FFP∶SRBC=1∶6)31例,中比例组(FFP∶SRBC=1∶4)32例,中高比例组(FFP∶SRBC=1∶2.5)32例,高比例组(FFP∶SRBC=1∶1.5)35例。观察并记录各组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)指标变化,记录各组患者的住院时间、生存率及不良反应发生情况,采用序贯器官衰竭(SOFA)评分评估患者预后。结果4组输血后12 h PT、APTT和TT 3项指标均较输血前明显延长(P<0.05),FIB明显下降(P<0.05),其中高比例组变化幅度最低,中高比例组、中比例组次之,低比例组最高,各组间差异均有统计学意义(P<0.05);输血后24 h,高比例组血PT、APTT、TT和FIB均达正常,其中PT、APTT和TT水平显著低于其他3组(P<0.05),FIB水平明显高于其他3组(P<0.05)。高比例组SOFA评分显著低于低比例组和中比例组(P<0.05),中高比例组SOFA评分显著低于低比例组(P<0.05)。结论FFP和SRBC按照1∶1.5的比例输注有利于维持创伤大输血患者的凝血功能,改善预后。

Objective To investigate the effects of different proportions of suspended red blood cells(SRBC)and fresh frozen plasma(FFP)on the coagulation function in the patients with traumatic big blood transfusion.Methods One hundred and thirty patients with trauma and once blood transfusion of SRBC>10 U served as the research subjects and divided into 4 groups according to different proportion of FFP and SRBC transfusion;the low proportion group(FFP∶SRBC=1∶6,31 cases),middle proportion group(FFP∶SRBC=1∶4,32 cases),middle and high proportion group(FFP∶SRBC=1∶2.5,32 cases)and high proportion group(FFP∶SRBC=1∶1.5,35 cases).The changes of prothrombin time(PT),activated partial clotting enzyme live time(APTT),thrombin time(TT)and fibrinogen(FIB)were recorded in each group.The hospitalization time,survival rate and adverse reaction situation were recorded in each group,and the situation after blood transfusion was evaluated by using the sequential organ failure assessment(SOFA).Results The 3 indexes of PT,APTT and TT at 12 h after blood transfusion in the four groups were significantly prolonged compared with those before transfusion(P<0.05),FIB was significantly decreased(P<0.05),in which the change amplitude in the high proportion group was lowest,followed by the middle-high proportion group and middle proportion group,the low proportion group was the highest,and the difference among the groups was statistically significant(P<0.05);at 24 h after blood transfusion,PT,APTT,TT and FIB in the high proportion group reached the normal levels,among them the PT,APTT and TT levels were significantly lower than those of the other three groups(P<0.05),and the FIB level was significantly higher than that of the other three groups(P<0.05).The SOFA score of the high proportion group was significantly lower than that of the low proportion group and middle proportion group(P<0.05),which of the middle and high proportion group was significantly lower than that of the low proportion group(P<0.05).Conclusion FFP and SRBC transfusion by 1∶1.5 is conducive to maintaining the coagulation function and improving the prognosis in the patients with traumatic big blood transfusion.