红细胞血浆联合冷沉淀输注用于产后大出血疗效观察

Effect of combined transfusion of concentrated red blood cells and cold precipitation on patients with postpartummajor hemorrhage

目的:探究分析浓缩红细胞联合冷沉淀治疗大出血患者的疗效及其对血清纤维蛋白原(Fbg)、纤维蛋白(FDP)水平的影响。方法:选取2018-01—2019-01收治的产后大出血患者80例,按照随机数字法分为观察组(40例)和对照组(40例)。对照组给予浓缩红细胞输血治疗后补充新鲜冰冻血浆(FFP),观察组在对照组基础上加用冷沉淀治疗。观察并记录患者治疗前后血液指标(PLT、PT、APTT、TT),输注前血清FDP、Fbg水平,输注15 min后FDP、Fbg,输注完毕血清FDP、Fbg,输注后不良反应等。结果:2组患者输注15 min、输注结束血液指标均较使用前明显改善(P<0.05),但观察组患者输注15 min、输注结束血液指标显著优于对照组(P<0.05)。2组患者治疗前后FDP比较差异明显(F=11.134,P=0.000;F=7.437,P=0.016;F=9.328,P=0.001),治疗前2组患者FDP比较差异无统计学意义(P>0.05),输注后2组患者FDP水平均显著降低,但观察组输注结束时FDP浓度显著低于对照组(P<0.05),2组患者治疗前后Fbg比较差异明显(F=12.135,P=0.000;F=8.443,P=0.011;F=10.254,P=0.000),治疗前2组患者Fbg比较差异无统计学意义(P>0.05),输注后2组患者Fbg水平均显著升高,但输注结束观察组患者Fbg浓度显著高于对照组(P<0.05)。2组患者输血后均未发生严重不良反应(输血相关溶血反应、心力衰竭、枸橼酸中毒、严重过敏性休克等、输血相关肺部不良反应等)。对照组患者输血后发现皮肤潮红2例,术后恶心呕吐2例,发热1例。观察组患者输血后发现皮肤潮红1例,术后恶心呕吐3例,发热2例,2组患者输血后不良反应发生率比较差异无统计学意义(P>0.05)。结论:浓缩红细胞与冷沉淀能有效改善大出血患者凝血功能及血清FDP、Fbg水平,且无明显不良反应,具有较高的安全性,值得在临床推广。

Objective:To explore and analyze the curative effect of combined transfusion of concentrated red blood cells and cold precipitation on the patients with postpartummajor bleeding and its effect on serum fibrinogen(Fbg) and fibrin(FDP) levels. Method:A cases of 80 postpartum hemorrhage admitted in our hospital from January 2018 to January 2019 were divided into observation group(40 cases)and control group(40 cases)according to the random number method.In the control group,fresh frozen plasma(FFP)was added after the treatment of concentrated red blood cell transfusion.In the observation group,cold precipitation was added on the basis of the control group.The blood indexes(PLT,PT,APTT,TT)were observed and recorded before and after treatment.The levels of serum FDP and Fbg were recorded before and after infusion.The adverse events were also recorded after infusion. Result:The blood indexes of the two groups were significantly improved(P<0.05),but the blood indexes of the observation group were significantly better than those of the control group(P<0.05).The FDP of the two groups before and after treatment was significantly different(F=11.134,P=0.000;F=7.437,P=0.016;F=9.328,P=0.001),and the FDP of the two groups before treatment was significantly different(F=7.437,P=0.016;F=9.328,P=0.001).There was no significant difference between the two groups(P>0.05),but the FDP concentration in the observation group was significantly lower than that in the control group at the end of infusion(P<0.05),and there was significant difference between the two groups before and after treatment(F=12.135,P=0.000;F=8.443,P=0.011;F=10.254,P=0.000).There was no significant difference between the two groups before and after infusion(P>0.05).The level of Fbg in the observation group was significantly higher than that in the control group(P<0.05).In the control group,2 patients had flush skin,2 patients had nausea and vomiting,and 1 patient had fever.In the observation group,1 patient was found to have flush skin,3 patients had nausea and vomiting,and 2 patients had fever.There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusion:Combined transfusion of concentrated red blood cells and cold precipitation could effectively adjust the coagulation function and serum FDP,FBG levels in the patients with postpartummassive hemorrhage,and there is no obvious adverse events,with high safety,which maybe worth popularizing in clinical practice.