自体输血对创伤性颅脑损伤患者凝血功能的影响分析

Effect of Autotransfusion on Coagulation for Patients with Traumatic Brain Injury

目的探讨自体输血对创伤性颅脑损伤患者凝血功能的影响。方法选取2016年1月至2019年6月在我院行急诊开颅术及去骨瓣减压术治疗的创伤性颅脑损伤患者82例,以随机数字表法分组。两组患者均行全麻下急诊开颅术及去骨瓣减压术,A组41例行回收式自体输血,B组41例采取稀释式自体输血。比较两组患者凝血功能、血红蛋白、红细胞比容、血清电解质水平及不良反应发生情况。结果术后两组患者PT及APTT均明显升高,FIB均明显下降(P<0.05),但术前、术后两组PT、APTT及FIB组间比较,差异均无统计学意义(P>0.05)。术后两组患者血红蛋白及红细胞比容均明显下降(P<0.05),但手术前后两组患者血红蛋白及红细胞比容组间比较,差异均无统计学意义(P>0.05)。术后两组患者Na^(+)、K^(+)及Cl-均明显下降(P<0.05),但手术前后两组患者Na^(+)、K^(+)及Cl-组间比较,差异均无统计学意义(P>0.05)。A组出现2例(4.88%)不良反应,1例寒战,1例发热;B组出现10例(24.39%)不良反应,其中皮疹3例,发热3例,寒战2例,急性肺损伤2例,两组差异有统计学意义(P<0.05)。结论行急诊开颅术及去骨瓣减压术的创伤性颅脑损伤患者采用稀释式自体输血与回收式自体输血对患者凝血功能、血红蛋白、红细胞比容及血清电解质水平的影响不明显,但回收式自体输血可降低术后并发症发生率。

Objective To investigate effect of autotransfusion on coagulation for patients with traumatic brain injury.Methods From January 2016 to June 2019,82 patients with traumatic brain injury who underwent emergency craniotomy and craniectomy decompression in our hospital were selected and grouped by random number table.Both groups underwent emergency craniotomy and decompressive craniectomy under general anesthesia.Group A(n=41)received recovery autotransfusion,and group B(n=41)received dilution autotransfusion.Coagulation function,hemoglobin,hematocrit,serum electrolyte levels and occurrence of adverse reactions were compared.Results Postoperative PT and APTT of two groups were significantly increased,and FIB were significantly decreased(P<0.05).But there was no statistically significant difference between preoperative and postoperative PT,APTT and FIB(P>0.05).The hemoglobin and hematocrit of patients decreased significantly after surgery(P<0.05),but there was no significant difference between hemoglobin and hematocrit before and after operation(P>0.05).Na^(+),K^(+)and Cl-decreased significantly after operation(P<0.05),but there were no statistically significant differences between Na^(+),K^(+)and Cl-groups before and after operation(P>0.05).There were 2 cases(4.88%)in group A with adverse reactions,1 case with chills and 1 case with fever.Group B had 10 cases(24.39%)with adverse reactions,including 3 cases of rash,3 cases of fever,2 cases of chills,and 2 cases of acute lung injury with statistically significant difference(P<0.05).Conclusion Patients with traumatic brain injury undergoing emergency craniotomy and decompressive craniectomy have little effect on coagulation function,hemoglobin,hematocrit,and serum electrolyte in patients with dilute autotransfusion and recovery autotransfusion,but recovery autotransfusion could reduce postoperative complications.