血小板去除术在创伤早期救治中的临床安全性及对免疫、凝血系统的影响研究

Clinical safety of platelet separation in early treatment of trauma and its effect on immune and coagulation system

目的探讨血小板去除术在创伤早期救治中的临床安全性及对免疫、凝血系统的影响。方法选取该院创伤中心2014年1月至2022年1月收治的40例创伤患者作为研究对象,其中需行血小板去除术的患者20例为观察组,无须行血小板去除术患者20例为对照组。比较两组患者治疗前后血小板计数(PLT)及形态变化、其他细胞成分、凝血指标、T细胞淋巴亚群的变化情况等相关指标。结果观察组患者治疗后PLT较治疗前明显降低,差异有统计学意义(P<0.05),但平均血小板体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)、大血小板百分比(P_LCR)比较差异无统计学意义(P>0.05);对照组患者治疗前后,PLT、MPV、红细胞压积(HCT)、PDW、P_LCR比较差异无统计学意义(P>0.05)。治疗前后,两组患者白细胞数(WBC)、红细胞数(RBC)、血红蛋白(HGB)、HCT组内比较差异均无统计学意义(P>0.05);组间比较,观察组中性粒细胞百分比(Neu%)高于对照组,差异有统计学意义(P<0.05)。治疗前后,两组凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-Di)组内比较差异均无统计学意义(P>0.05);组间比较,观察组D-Di高于对照组,差异有统计学意义(P<0.05)。治疗前后,两组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)组内比较差异均无统计学意义(P>0.05);组间比较,对照组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)高于观察组,差异有统计学意义(P<0.05)。观察组患者治疗中的收缩压、舒张压、心率、氧饱和度与治疗前、治疗后存在差异(P<0.05),而呼吸频率差异无统计学意义(P>0.05)。结论血小板去除术在早期创伤患者综合救治策略中安全性可靠,对免疫及凝血指标影响较小。

Objective To explore the clinical safety of platelet(PLT)separation in early treatment of trauma and its effect on immune and coagulation system.Methods A total of 40 patients hospitalized and treated in the Center of Emergency and Trauma of this hospital form January 2014 to January 2022 were selected as the study subjects,among them 20 cases needing the PLT separation served as the observation group and the other 20 cases without needing the PLT separation as the control group.The number and morphological changes of PLT,peripheral blood cell composition,coagulation indexes,changes of immune T cell lymphocyte subsets and other related indicators before and after treatment were compared between the two groups.Results The peripheral blood PLT count after treatment in the observation group was significantly decreased compared with that before operation,and the difference was statistically significant(P<0.05).But the mean MPV,PCT,PDW and P_LCR had no statistically significant difference(P>0.05).There was no statistically significant difference in PLT,MPV,HCT,PDW and P_LCR in the control group between before and after treatment(P>0.05).The WBC count,RBC count,levels of HGB and HCT before and after treatment between the two groups and within the group had no statistical differences(P>0.05),but in the inter-group comparison,the level of Neu%in the observation group was higher than that in the control group(P<0.05).There were no differences in PT,INR,APTT,TT and D-Di between groups and within groups(P>0.05),while in the inter-group comparison,the D-Di level in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).The levels of peripheral blood CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)before and after treatment had no statistical differences between the two groups(P>0.05),but in the inter-group comparison,the levels of CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in the control group were higher than those in the observation group,and the differences were statistically significant(P<0.05).The systolic blood pressure,diastolic blood pressure,heart rate,respiratory rate,and oxygen saturation of patients in the observation group before,during,and after platelet separation were compared.Compared with preoperative and postoperative,the intraoperative systolic blood pressure,diastolic blood pressure,heart rate and oxygen saturation in the observation had statistically significantly differences between before and after treatment(P<0.05),while there was no statistical difference in the respiratory rate(P>0.05).Conclusion The platelet separation is safe and reliable in the comprehensive treatment strategy of early trauma patients,and has little effect on immune and coagulation indexes,and is worthy to be recommended in the clinical treatment of trauma.