冷沉淀联合新鲜冰冻血浆输注对急诊外伤大量输血患者凝血功能、炎症及免疫功能的影响

Effect of cryoprecipitate combined with fresh frozen plasma infusion on coagulation function,inflammation and immune function in emergency trauma patients receiving massive blood transfusion

目的:研究冷沉淀联合新鲜冰冻血浆输注对急诊外伤大量输血患者凝血功能、炎症及免疫功能的影响。方法:选择2015年3月~2017年12月期间在我院急诊接受大量输血(输血量≥1600 ml)的外伤患者,分为接受冷沉淀联合新鲜冰冻血浆输注的观察组和新鲜冰冻血浆输注的对照组。输血前及输血后24 h,测定凝血功能指标、炎症及免疫功能指标。结果:与输血前比较,两组输血后24 h的TT、PT、APTT均延长,血清FIB水平均显著降低,TNF-α、IL-6、IFN-γ、sCD40L水平及T淋巴细胞亚群CD3^+/CD4^+、CD3^+/CD8^+、CD16^+/CD56^+均显著升高(P<0.001)且观察组输血后24 h的TT、PT、APTT均显著短于对照组,FIB水平及T淋巴细胞亚群CD3^+/CD4^+、CD3^+/CD8^+、CD16^+/CD56^+显著高于对照组,TNF-α、IL-6、IFN-γ、sCD40L水平显著低于对照组(P<0.001)。结论:冷沉淀输注对急诊外伤大量输血患者的凝血功能及免疫功能具有改善作用,对炎症反应具有抑制作用。

Objective:To study the effects of cryoprecipitate combined with fresh frozen plasma infusion on coagulation function,inflammation and immune function in emergency trauma patients receiving massive blood transfusion.Methods:Trauma patients receiving massive blood transfusion(blood transfusion over 1600 ml)in emergency department of our hospital during March 2015 to December 2017 were selected and divided into observation group receiving cryoprecipitate combined with fresh frozen plasma infusion,and control group receiving fresh frozen plasma infusion.Before and 24 hours after blood transfusion,coagulation function indexes,inflammation and immune function indexes were measured.Results:Compared with those before blood transfusion,TT,PT and APTT of two groups prolonged,FIB levels decreased,TNF-α,IL-6,IFN-γ,sCD40L levels and T lymphocyte subsets CD3^+/CD4^+,CD3^+/CD8^+,CD16^+/CD56^+were all increased(P<0.001)and 24 hours after blood transfusion,TT,PT and APTT of observation group were significantly shorter than control group,FIB levels and T lymphocyte subsets CD3^+/CD4^+,CD3^+/CD8^+,CD16^+/CD56^+were significantly higher than control group,TNF-α,IL-6,IFN-γ,sCD40L levels were significantly lower than control group(P<0.001).Conclusion:cryoprecipitate infusion can improve coagulation function and immune function of emergency trauma patients who receiving massive blood transfusion and inhibit inflammatory reaction.