不同输血量干预对老年严重创伤患者凝血功能的影响

The Effect of Different Blood Transfusion Volume Interventions on Coagulation Function in Elderly Patients with Severe Trauma

【目的】探讨不同输血量干预对老年严重创伤患者凝血功能的影响。【方法】在本院治疗的110例严重创伤患者,随机分为观察组和对照组,每组55例。所有患者均给予吸氧、抗感染、抗休克等基础治疗。对照组行少量输血干预,观察组行大量输血干预,密切监护患者输血干预后生命体征变化。比较两组患者干预前及干预后3 d炎症指标、凝血功能指标、血气指标及创伤多器官功能不全综合征(MODS)的发生率及病死率。【结果】两组患者干预后3 d的C-反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平显著高于干预前(P<0.05),且观察组各指标水平高于对照组(P<0.05);两组患者干预后3 d的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)显著高于干预前,纤维蛋白原(FIB)、血小板计数(PLT)水平显著低于干预前(P<0.05),且观察组患者PT、APTT、TT高于对照组,FIB、PLT水平低于对照组(P<0.05);两组患者干预后3 d的酸碱度(pH)、动脉血氧分压(PaO_(2))水平显著高于干预前,动脉血二氧化碳分压(PaCO_(2))水平显著低于干预前(P<0.05),且观察组患者pH、PaO_(2)水平高于对照组,PaCO_(2)水平低于对照组(P<0.05);观察组MODS发生率及病死率均显著低于对照组(P<0.05)。【结论】老年严重创伤患者应用大量输血干预后可有效补充患者血容量,改善血气指标,降低病死率,但易引发炎症反应,导致凝血功能障碍。因此,对老年严重创伤患者应用输血干预时应合理控制输血量,密切监测凝血功能等相关指标。

【Objective】To observe the effect of different transfusion volumes on coagulation function in elderly patients with severe trauma.【Methods】A total of 110 severe trauma patients treated in our hospital were randomly divided into an observation group and a control group,with 55 cases in each group.All patients were given basic treatments such as oxygen therapy,anti infection,and anti shock.The control group received a small amount of blood transfusion intervention,while the observation group received a large amount of blood transfusion intervention,closely monitoring the changes in vital signs of patients after blood transfusion intervention.We compared the incidence and mortality rates of inflammation,coagulation function,blood gas,and multiple organ dysfunction syndrome(MODS)in two groups of patients before and three days after intervention.【Results】Three days after intervention,the levels of C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the two groups of patients were significantly higher than before intervention(P<0.05),and the levels of various indicators in the observation group were higher than those in the control group(P<0.05);Three days after intervention,the levels of prothrombin time(PT),activated partial thromboplastin time(APTT),and thrombin time(TT)in two groups of patients were significantly higher than before intervention,while the levels of fibrinogen(FIB)and platelet count(PLT)were significantly lower than before intervention(P<0.05).In addition,the levels of PT,APTT,and TT in the observation group were higher than those in the control group,while the levels of FIB and PLT were lower than those in the control group(P<0.05);Three days after intervention,the pH and arterial oxygen pressure(PaO_(2))levels of the two groups of patients were significantly higher than before intervention,and the arterial carbon dioxide pressure(PaCO_(2))levels were significantly lower than before intervention(P<0.05).In addition,the pH and PaO_(2)levels of the observation group were higher than those of the control group,and the PaCO_(2)levels were lower than those of the control group(P<0.05);The incidence and mortality rate of MODS in the observation group were significantly lower than those in the control group(P<0.05).【Conclusion】The application of extensive blood transfusion intervention in elderly patients with severe trauma can effectively supplement their blood volume,improve blood gas indicators,and reduce mortality,but it is prone to trigger inflammatory reactions and lead to coagulation dysfunction.Therefore,when applying blood transfusion intervention to elderly patients with severe trauma,it is necessary to reasonably control the transfusion dose and closely monitor relevant indicators such as coagulation function.