48例严重创伤失血性休克患者应用火急非同型输血抢救的临床分析

Clinical Analysis of 48 Patients With Severe Traumatic Hemorrhagic Shock Rescued by Emergency Non⁃Identical Blood Transfusion

目的:分析48例严重创伤失血性休克患者应用火急非同型输血抢救的临床效果。方法:回顾性分析2019年7月-2023年7月我院急诊科应用火急非同型输血抢救的48例严重创伤失血性休克患者(均为O型去白细胞悬浮红细胞输注)的临床资料。记录48例患者抢救情况[输血等候时间、24 h抢救成功率]、去白细胞悬浮红细胞输注量。记录输血前和输血后12 h时抢救成功患者凝血功能[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、溶血指标[总胆红素(TBIL)、间接胆红素(IBIL)]的变化。结果:48例患者输血等候时间平均(15.22±2.39)min;去白细胞悬浮红细胞输注量为:42例输注3U,3例输注4.5U,3例输注1.5U;24 h抢救成功率为87.50%(42/48)。输血后12 h时,抢救成功患者PT、APTT水平显著低于输血前(P<0.05);TBIL、IBIL水平略高于输血前,但差异无统计学意义(P>0.05)。结论:火急非同型输血用于抢救严重创伤失血性休克患者中有利于缩短输血等候时间,提高抢救效率,且安全性良好。

Objective:To analyze the clinical effect of emergency non-identical blood transfusion rescue on 48 pa-tients with severe traumatic hemorrhagic shock.Methods:The clinical data of 48 patients with severe traumatic hemor-rhagic shock(all O-type leukocyte-depleted suspended red blood cell transfusion)who were rescued by emergency non-identical blood transfusion in emergency department of our hospital from July 2019 to July 2023 were retrospectively ana-lyzed.The rescue situation(blood transfusion waiting time,24 h rescue success rate)and leukocyte-depleted suspended red blood cell transfusion volume were recorded among 48 patients.The changes in coagulation function[plasma pro-thrombin time(PT),activated partial thromboplastin time(APTT)],thrombelastogram[coagulation reaction time(R),maximum amplitude of thrombus(MA)]and hemolysis indicators[total bilirubin(TBIL),indirect bilirubin(IBIL)]were recordedamong patients with successful rescue before blood transfusion and at 12 h after blood transfusion.The level of plasma free hemoglobin(FHb)at 12 h after blood transfusion was recorded among patients with successful rescue.Results:The average blood transfusion waiting time of 48 patients was(15.22±2.39)min,theleukocyte-deplet-ed suspended red blood cell transfusion volume was 3U in 42 cases,4.5U in 3 cases and 1.5U in 3 cases,and the suc-cess rate of 24 h rescue was 87.50%(42/48).At 12 h after blood transfusion,the PT,APTT and R in patients with suc-cessful rescue were significantly shorter or lower than those before blood transfusion(P<0.05)while the level of MA was significantly higher than that before blood transfusion(P<0.05).The levels of TBIL and IBIL were slightly higher than those before blood transfusion(P>0.05).Conclusion:Emergency non-identical blood transfusion is helpful to shorten the waiting time of blood transfusion and improve the rescue efficiency in the rescue of patients with severe traumatic hemorrhagic shock,and it has good safety.