3种不同比例血浆与红细胞输注治疗严重多发伤失血性休克的疗效分析

Efficacy Analysis of Three Different Proportions of Plasma to Red Blood Cell Infusion for Hemorrhagic Shock Accompanied by Severe Multiple Injuries

目的探讨3种不同比例血浆与红细胞输注在严重多发伤失血性休克患者中的治疗效果。方法选取淮安市第二人民医院2019年1月至2022年6月就诊的严重多发伤失血性休克患者60例,按照治疗时选用不同比例的新鲜冻血浆(FFP)与红细胞悬液(RBCs)将患者分为3组:低比例组(1:3)、中比例组(1:2)、高比例组(1:1),每组20例。比较3组血液制品用量(RBCs、血小板、冷沉淀)、输血前后血常规指标(Hb、PLT)、凝血功能指标(FIB、APTT、PT)、血栓弹力图相关参数[血块生成时间(K值)、凝血反应时间(R值)、最大宽度值(MA)、血块生成率(α角)]、炎性因子(IL-8、IL-6、TNF-α)水平及预后情况(住院时间、病死率)。结果3组RBCs、血小板、冷沉淀用量比较,差异无统计学意义(均P>0.05)。3组FFP用量比较,高比例组低于中、低比例组(均P<0.05)。输血后中、高比例组PLT高于低比例组(均P<0.05)。与中、低比例组比较,输血后高比例组PT、APTT更短,FIB、MA、α角更高,K值、R值更低(均P<0.05)。3组血清IL-6、IL-8、TNF-α水平在输血后较输血前降低(均P<0.05),但各组间比较差异无统计学意义(均P>0.05)。3组住院时间、病死率比较,差异无统计学意义(均P>0.05)。结论治疗严重多发伤失血性休克患者时,FFP与RBCs高比例(1:1)输注可更好地改善患者凝血功能障碍,减轻炎症反应,且更经济安全。

Objective To investigate the effects of three different proportions of plasma to red blood cell infusion on hemorrhagic shock after severe multiple traumas.Methods Sixty patients with hemorrhagic shock after severe multiple injuries who were treated in Huai'an Second People's from January 2019 to June 2022 were selected as the subjects.According to the ratios of fresh frozen plasma(FFP) to red blood cell suspension(RBCs),these patients were divided into three groups:low proportion group(1:3),medium proportion group(1:2) and high proportion group(1:1),with 20 patients in each group.The dosages of blood products(RBCs,platelet and cryoprecipitate),routine blood indexes(hemoglobin(Hb) and platelet count(PLT)),coagulation function indicators(fibrinogen(FIB),activated partial thromboplastin time(APTT) and prothrombin time(PT)),thrombelastogram-related parameters(clot formation time(K value),clot reaction time(R value),maximum width value(MA) and clot formation rate(α Angle)),inflammatory factors(interleukin-8(IL-8),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α),and prognosis(hospital stay and mortality) were compared among the three groups.Results There were no significant differences in the dosages of RBCs,platelets and cryoprecipitate among the three groups(P>0.05).The dosage of FFP in the high proportion group was lower than that in the medium or low proportion group(P<0.05).After blood transfusion,the PLT in the medium or high proportion group was higher than that in the low proportion group(P<0.05).At 24 hours after transfusion,compared with the medium or low proportion group,PT and APTT were shortened,FIB,MA and α angle were increased,and K value and R value were reduced in the high proportion group(P<0.05).The serum levels of IL-6,IL-8 and TNF-α decreased 24 hours after transfusion in all the three groups(P<0.05),while the differences were not significant between groups(P>0.05).In addition,there were no remarkable differences in hospital stay and mortality among the three groups(P>0.05).Conclusion As an economical and safe treatment,the infusion of FFP and RBCs in 1:1 ratio can improve coagulation dysfunction and reduce inflammatory response in patients with hemorrhagic shock after severe multiple injuries.