单采血小板联合冷沉淀凝血因子治疗创伤性大出血的临床效果观察

Efficacy of apheresis platelets combined with cryoprecipitated antihemophilic factor in the treatment of traumatic hemorrhage

目的观察单采血小板联合冷沉淀凝血因子治疗创伤性大出血的临床效果。方法选取2019年1月至2022年1月在西湖大学医学院附属杭州市第一人民医院接受输血治疗的80例创伤性大出血患者为研究对象,其中予以单采血小板治疗40例,为对照组;单采血小板联合冷沉淀凝血因子治疗40例,为观察组。比较两组患者输血前后凝血功能指标[包括凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)]、血常规指标[包括血红蛋白(Hb)、红细胞比容(HCT)、血小板计数(PLT)]、血栓弹力图参数[包括凝血反应时间(R)、α角度(Angle)、血栓形成最大振幅(MA)、纤维蛋白溶解指标LY30]以及止血情况、住院时间、临床结局。结果观察组止血时间明显短于对照组(P<0.05)。两组患者输血后PT、APTT、TT、R较输血前均明显降低(均P<0.05),且观察组均低于对照组(均P<0.05);Fib、Hb、HCT、PLT、Angle、MA、LY30较输血前均明显升高(均P<0.05),且观察组Fib、HCT、Angle、MA均高于对照组(均P<0.05)。两组患者住院时间及治疗结局比较,差异均无统计学意义(均P>0.05)。结论单采血小板联合冷沉淀凝血因子治疗创伤性大出血能缩短止血时间,明显改善患者凝血功能,但在改善临床结局方面较单采血小板治疗无明显优势。

Objective To observe the efficacy of apheresis platelet combined with cryoprecipitated antihemophilic factor(Cryo)in the treatment of massive traumatic hemorrhage.Methods Eighty patients with traumatic hemorrhage who received blood transfusion in Hangzhou First People's Hospital Affiliated to Westlake University School of Medicine from January 2019 to January 2022 were enrolled.Among them,40 patients were treated with apheresis platelet(control group),the other 40 patients were treated with apheresis platelet combined with Cryo(observation group).Indicators of coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fib)],blood routine index[hemoglobin(Hb),hematocrit(HCT),platelet count(PLT)],thromboelastography(TEG)parameters[including coagulation reaction time(R),αangle(Angle),maximum thrombosis amplitude(MA),fibrinolytic index LY30]before and after treatment,hemostatic effect,hospitalization time and outcome were compared between the two groups.Results Hemostasis time was significantly shorter in the observation group than in the control group(P<0.05).After blood transfusion,PT,APTT,TT and R decreased in both groups(all P<0.05),and were significantly lower in the observation group than in the control group(all P<0.05).Fib,Hb,HCT,PLT,Angle,MA and LY30 were significantly higher after blood transfusion than before in both groups(all P<0.05),and were significantly higher in the observation group than in the control group(all P<0.05).Fib,HCT,Angle and MA were significantly higher in the observation group than in the control group(all P<0.05).There was no significant difference in the length of hospital stay and outcome between the two groups(both P>0.05).Conclusion Apheresis platelet combined with Cryo in the treatment of massive traumatic hemorrhage can shorten the hemostasis time,and significantly improve the coagulation function,but it has no obvious advantage in improving the clinical outcome compared to the apheresis platelet therapy.