159例体外膜肺氧合支持治疗患者血液输注回顾性分析

Blood transfusion strategies in patients on extracorporeal membrane oxygenation

目的 回顾性分析本院159例行体外膜肺氧合(ECMO)支持治疗患者的血液输注情况,探讨血液输注在ECMO支持治疗中的临床应用及疗效评价。方法 选择2017年10月~2021年10月本院接受ECMO治疗患者,分析不同ECMO模式治疗期间血液输注情况、凝血监测指标并对血液输注疗效进行评价。结果 不同ECMO治疗模式对于输血人次无差异,VA模式下红细胞、血浆、血小板输注量分别为(28.35±14.60)U、(7 367.78±5 194.33)mL、(7.04±5.10)治疗量,均高于VV模式下输注量(18.67±21.50)U、(4 836.67±6 640.50)ml、(3.60±7.47)治疗量。VA-ECMO模式下ECMO治疗前血红蛋白水平及血小板计数分别为(126.44±23.9)g/L、(223.84±67.62)×10~9/L,均显著高于治疗结束后水平(91.02±21.48)g/L、(172.86±127.73)×10~9/L。VV-ECMO模式下ECMO治疗前APTT(35.28±8.73)s短于治疗后(41.96±13.69)s,纤维蛋白原、血红蛋白水平及Plt分别为(3.80±1.85)g/L、(123.81±33.77)g/L、(175.72±98.91)×10~9/L,均显著高于治疗结束后水平(2.78±1.08)g/L、(92.31±17.38)g/L、(125.31±98.14)×10~9/L。结论 ECMO治疗期间不同模式输血量存在差异,血液输注是保障ECMO治疗的必要支持手段,开展凝血指标的监测有利于减少血液输注,提高输血疗效,保障患者安全。

Objective To analyze the blood transfusion strategies in extracorporeal membrane oxygenation(ECMO) recievers in our hospital, so as to explore the clinical application and efficacy of blood transfusion in patients on ECMO. Methods Data from patients on ECMO treatment in our hospital from October 2017 to October 2021 was collected. The blood transfusion data and coagulation monitoring indexes during different ECMO modes were analyzed, and the efficacy of blood transfusion was evaluated. Results No difference in the number of blood transfusions was noticed by ECMO treatment modes.The transfusion units of red blood cells, plasma and platelets in VA mode were(28.35±14.60) U,(7 367.78±5 194.33) mL and(7.04±5.10) therapeutic volumes, which were higher than those in VV mode, i.e.(18.67±21.50) U,(4 836.67±6 640.50) mL and(3.60±7.47) therapeutic dose, respectively.In VA-ECMO mode, the Hb level and platelet count before ECMO treatment were(126.44±23.9) g/L and(223.84±67.62) × 10~9/L, which were significantly higher than those after treatment(91.02±21.48) g/L and(172.86±127.73)×10~9/L.In VV-ECMO mode, the APTT before ECMO treatment was(35.28±8.73) s, which was shorter than that after treatment(41.96±13.69) s. The levels of fibrinogen, Hb and platelet count were(3.80±1.85) g/L,(123.81±33.77) g/L and(175.72±98.91)×10~9/L, which were significantly higher than the levels after treatment(2.78±1.08) g/L,(92.31±17.38) g/L and(125.31±98.14)×10~9/L, respectively. Conclusion There are differences in the amount of blood transfusion among different modes of ECMO treatment. As blood transfusion is a necessary support to ensure ECMO treatment, the monitoring of coagulation index is conducive to reduce blood transfusion, improve the efficiency of blood transfusion and benefit to patient safety.