限制性输血对急性上消化道出血患者凝血功能及血液流变学指标的影响

Effect of Restricted Blood Transfusion on Coagulation Function and Hemorheology Index in Patients with Acute Upper Gastrointestinal Bleeding

目的:研究限制性输血对急性上消化道出血(AUGB)患者凝血功能及血液流变学指标的影响。方法:选取2020年1月—2021年5月江门市人民医院输血科收治的81例AUGB患者,按随机数表法分为对照组(n=40)、观察组(n=41)。对照组采用开放性输血,观察组予以限制性输血;比较两组输血后24 h、48 h和72 h的止血率,比较两组输血前和输血72 h后凝血功能、血液流变学指标及输血后不良反应发生率。结果:输血后24 h,观察组止血率显著高于对照组,差异有统计学意义(P<0.05);输血后48 h和72 h,两组止血率比较,差异无统计学意义(P>0.05)。输血前,两组凝血指标比较,差异无统计学意义(P>0.05);输血后,两组血浆纤维蛋白原(FIB)水平高于输血前,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)水平低于输血前,且观察组FIB水平高于对照组,PT、APTT、D-D水平低于对照组,差异有统计学意义(P<0.05)。输血前,两组血液流变学指标比较,差异无统计学意义(P>0.05);输血后,两组血浆黏度、全血黏度、红细胞比容均显著高于输血前,且观察组均高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为4.88%,显著低于对照组的22.50%,差异有统计学意义(P<0.05)。结论:限制性输血可有效提高AUGB患者输血后24 h止血率,改善患者凝血功能和血液流变学状况,降低不良反应发生率。

Objective:To investigate the effects of restricted blood transfusion on coagulation function and hemorheology index in patients with acute upper gastrointestinal bleeding(AUGB).Method:A total of 81 AUGB patients admitted to the Blood Transfusion Department of Jiangmen People's Hospital from January 2020 to May 2021 were selected and divided into control group(n=40)and observation group(n=41)according to random number table method.The control group received open blood transfusion,and the observation group received restricted blood transfusion.The hemostatic rate of 24 h,48 h and 72 h after transfusion were compared between the two groups,and the coagulation function,hemorheology indexes before and 72 h after transfusion and the incidence of adverse reactions after transfusion were compared between the two groups.Result:At 24 h after blood transfusion,the hemostatic rate in the observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).There were no significant differences in hemostatic rate between the two groups at 48 h and 72 h after transfusion(P>0.05).Before blood transfusion,there were no significant differences in coagulation indexes between the two groups(P>0.05).After blood transfusion,plasma fibrinogen(FIB)level of the two groups were higher than those before transfusion,and plasma prothrombin time(PT),activated partial thromboplastin time(APTT)and D-dimer(D-D)levels were lower than those before transfusion,the FIB levels in observation group was significantly higher than that in control group,while PT,APTT and D-D levels were lower than those in control group,the differences were statistically significant(P<0.05).Before blood transfusion,there were no significant differences in hemorheology indexes between the two groups(P>0.05).After blood transfusion,plasma viscosity,whole blood viscosity and erythrocyte specific volume in the two groups were significantly higher than those before blood transfusion,and observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 4.88%,which was significantly lower than 22.50%in the control group,and the difference was statistically significant(P<0.05).Conclusion:Restricted blood transfusion can effectively improve the hemostatic rate 24 h after transfusion,improve the coagulation function and hemorheology indexes status of patients with AUGB,and reduce the incidence of adverse reactions.