大剂量成分输血方案在危急重症患者抢救中的应用效果

Application effect of massive blood component transfusion protocol in rescue of critically ill patients

目的探讨大剂量成分输血方案在危急重症患者抢救中的应用效果。方法选择实施抢救中需大剂量输血的200例危急重症患者作为研究对象,按输血方案将患者分为观察组与对照组,每组100例。观察组患者采用特定比例的大剂量成分输血方案(红细胞3 U、新鲜冰冻血浆400 mL、新鲜/冰冻AB型血小板1 U),对照组患者采用大剂量全血输血方案。比较两组患者输血治疗前后的凝血功能指标[部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平、凝血酶时间(TT)]和血栓弹力图指标[血凝块形成时间(K)、凝血反应时间(R)、凝固角(α)、凝血最大振幅(MA)],以及两组患者术中出血量、输血总量、各成分输血量、输血临床疗效、住院期间输血不良反应发生情况和住院时间。结果输血治疗结束24 h后,两组患者的APTT、PT及TT均较输血前延长,FIB水平较输血前降低,R值、K值均高于输血前,α值、MA值均低于输血前,而观察组APTT、PT、TT、R值、K值均低于对照组,FIB水平、α值、MA值均高于对照组(均P<0.05)。两组患者术中出血量和输血总量比较,差异均无统计学意义(均P>0.05),而观察组术后异体悬浮红细胞、冰冻血浆、单采血小板的输入量均低于对照组(均P<0.05)。观察组输血临床疗效优于对照组,且不良反应发生率和住院时间均低于或短于对照组(均P<0.05)。结论对于需要大剂量输血治疗的危急重患者,采用特定比例的成分输血(红细胞3 U、新鲜冰冻血浆400 mL、新鲜/冰冻AB型血小板1U)疗效优于全血输血,可改善患者的凝血功能,降低不良反应发生率。

Objective To explore the application effect of massive blood component transfusion protocol in the rescue of critically ill patients. Methods A total of 200 critically ill patients needing massive blood transfusion in the rescue were selected as research subjects. They were divided into observation group and control group according to their blood transfusion protocols, with 100 cases in each group. Patients in the observation group used a massive blood component transfusion protocol with a specific proportion(3 U of red blood cells, 400 mL of fresh frozen plasma, and 1 U of fresh/frozen group AB platelets), and patients in the control group used a massive whole blood transfusion protocol. The coagulation function indicators(activated partial thromboplastin time[APTT], prothrombin time[PT], fibrinogen[FIB] level, thrombin time[TT]) and the indices of thromboelastograpy(clotting time[K], coagulation reaction time[R], coagulation angle[α], maximum amplitude[MA]) before and after blood transfusion therapy, the volume of intraoperative bleeding, the total volume of blood transfusion, the infusion volumes of blood components, the clinical efficacy of blood transfusion, the incidence of blood transfusion-related adverse reactions during hospitalization, and the length of hospital stay were compared between the two groups. Results Twenty-four hours after the end of blood transfusion therapy, APTT, PT and TT were prolonged, FIB level was decreased, R value and K value were higher, and α value and MA value were lower in both groups as compared with those before blood transfusion;whereas the observation group exhibited decreased APTT, PT, TT, R value, and K value, and higher FIB level, α value, and MA value than the control group(all P<0.05). There was no statistically significant difference in the volume of intraoperative bleeding or the total volume of blood transfusion between the two groups(all P>0.05), whereas the infusion volumes of allogeneic suspended red blood cells, frozen plasma, and apheresis platelets after the operation in the observation group were lower than those in the control group(all P<0.05). The observation group achieved superior clinical efficacy of blood transfusion, a lower incidence rate of adverse reactions, and a shorter length of hospital stay than the control group(all P<0.05).Conclusion For critically ill patients who need the therapy of massive blood transfusion, blood component transfusion with a specific proportion(3 U of red blood cells, 400 mL of fresh frozen plasma, and 1 U of fresh/frozen group AB platelets) exerts better efficacy than whole blood transfusion, which can improve patients′ coagulation function and reduce the incidence rate of adverse reactions.