大量输血对急性创伤患者凝血功能和纤溶系统的影响

Effect of massive blood transfusion on coagulation function and fibrinolytic system in patients with acute trauma

目的分析大量输血对急性创伤患者凝血功能和纤溶系统的影响。方法45例需要输血的急性创伤患者,根据患者早期输血量分为观察组(25例)和对照组(20例)。观察组实施大量输血进行治疗,对照组实施少量输血进行治疗。比较两组患者凝血指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]及血小板计数(PLT)、蛋白C(PC)、纤溶系统指标[D-二聚体(D-D)、纤维蛋白降解产物(FDP)]水平。结果观察组患者PT(18.4±4.3)s、APTT(42.0±7.0)s、TT(21.4±4.8)s均长于对照组的(14.8±1.9)、(36.1±5.4)、(17.2±3.3)s,FIB(2.8±0.8)g/L低于对照组的(3.4±1.0)g/L,差异具有统计学意义(P<0.05)。观察组患者D-D和FDP水平均高于对照组,PLT及PC水平均低于对照组,差异具有统计学意义(P<0.05)。结论大量输血治疗对急性创伤患者凝血功能和纤溶功能影响较大,所以必须随时监测凝血功能和纤溶功能,以防止出现凝血功能异常等并发症,增加大量输血治疗方法的可靠性。

Objective To analyze the effect of massive blood transfusion on coagulation function and fibrinolytic system in patients with acute trauma.Methods A total of 45 cases of acute trauma patients requiring blood transfusion were divided into observation group(25 cases)and control group(20 cases)according to the amount of early blood transfusion.The observation group received a large amount of blood transfusion for treatment,and the control group received a small amount of blood transfusion for treatment.Both groups were compared in terms of coagulation indexes[prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB)],platelet count(PLT),protein C(PC),fibrinolytic system indicators[D-dimer(D-D),fibrin degradation products(FDP)]levels.Results The PT(18.4±4.3)s,APTT(42.0±7.0)s and TT(21.4±4.8)s in the observation group were all longer than(14.8±1.9),(36.1±5.4),and(17.2±3.3)s in the control group,and the FIB(2.8±0.8)g/L was lower than(3.4±1.0)g/L in the control group.All the differences were statistically significant(P<0.05).The levels of D-D and FDP in the observation group were higher than those in the control group,and the levels of PLT and PC were lower than those in the control group.All the differences were statistically significant(P<0.05).Conclusion Mass blood transfusion has a great impact on coagulation and fibrinolysis in patients with acute trauma,so it is necessary to monitor the blood coagulation and fibrinolytic function at any time,aiming to prevent the occurrence of complications such as abnormal coagulation function and increase the reliability of massive blood transfusion.