新鲜冰冻血浆与浓缩红细胞高比例输注对严重创伤大量输血患者凝血功能及免疫功能的影响

Effect of High Proportion Transfusion of Fresh Frozen Plasma and Concentrated Red Blood Cell on Coagulation Function and Immune Function in Patients with Severe Trauma and Massive Transfusion

目的:探讨新鲜冰冻血浆与浓缩红细胞(CRBC)高比例输注对严重创伤大量输血患者凝血功能及免疫功能的影响。方法:选取枝江市人民医院2018年5月—2021年5月收治的128例严重创伤大量输血患者进行研究,将其随机分为两组,对照组64例采用新鲜冰冻血浆与CRBC低比例输注(1︰3),观察组64例采用新鲜冰冻血浆与CRBC高比例输注(1︰1),对两组输血前及输血后1 d免疫指标、凝血功能指标情况及其他相关指标进行对比。结果:两组输血前、输血后1 d免疫功能指标对比,差异均无统计学意义(P>0.05)。两组输血前各凝血功能指标比较,差异均无统计学意义(P>0.05);观察组输血后1 d凝血活酶时间(APTT)、凝血酶原时间(PT)、血浆凝血酶时间(TT)均低于对照组,纤维蛋白原(FIB)、血小板(PLT)均高于对照组,差异均有统计学意义(P<0.05)。观察组输血后序贯器官衰竭(SOFA)评分低于对照组,差异有统计学意义(P<0.05),两组住院时间、不良反应发生率比较,差异无统计学意义(P>0.05)。结论:新鲜冰冻血浆与CRBC比例输注在改善严重创伤大量输血患者免疫功能方面有较好的效果,但相对而言,高比例输注对患者凝血功能的改善效果更为理想。

Objective:To investigate the effect of high proportion transfusion of fresh frozen plasma and concentrated red blood cell(CRBC)on coagulation function and immune function in patients with severe trauma and massive transfusion.Method:A total of 128 patients with severe trauma and massive transfusion who admitted to Zhijiang People's Hospital from May 2018 to May 2021 were selected,and they were randomly divided into two groups,64 in the control group were given fresh frozen plasma to CRBC low ratio transfusion(1︰3),and 64 in the observation group were given fresh frozen plasma to CRBC high ratio transfusion(1︰1),and the immune indicators,coagulation function indicators and other related indicators of two groups before transfusion and 1 d after transfusion were compared.Result:There were no significant differences in immune function indexes between two groups before and 1 d after blood transfusion(P>0.05).There were no significant differences in coagulation function between two groups before blood transfusion(P>0.05);the prothrombin time(APTT),prothrombin time(PT)and plasma thrombin time(TT)in the observation group at 1 d after blood transfusion were lower than those in the control group,and the fibrinogen(FIB)and platelet(PLT)were higher than those in the control group,the differences were statistically significant(P<0.05).The sequential organ failure assessment(SOFA)score of the observation group after blood transfusion was lower than that of the control group,and the difference was statistically significant(P<0.05).There were no statistically significant differences in terms of hospital stay and incidence of adverse reactions between two groups(P>0.05).Conclusion:Fresh frozen plasma to CRBC ratio transfusion has a better effect in improving the immune function of patients with severe trauma and massive transfusion,but relatively,a high ratio transfusion has a more desirable effect on the improvement of patients'coagulation function.