血液制品中血浆与红细胞比例对严重创伤成分输血效果的影响

Influence of the ratio of plasma to red blood cells in the infused blood products on component blood transfusion for severe trauma

目的探讨血液制品中血浆与红细胞比例对严重创伤成分输血效果的影响。方法回顾性分析2019年2月至2022年12月商丘市第一人民医院收治的186例严重创伤患者的临床资料,按照输注血液制品中血浆与红细胞的比例分为对照组和研究组,每组93例。对照组患者输注血浆与红细胞比例为1∶2的血液制品,研究组患者输注血浆与红细胞比例为1∶1的血液制品。比较两组患者输血前、输血24 h后血常规指标[血红蛋白(Hb)、血小板计数(PLT)]、凝血功能[纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、免疫功能[T细胞亚群(CD4^(+)、CD3^(+))]、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平及临床指标(血容量恢复时间、ICU住院时间)。结果输血24 h后,研究组Hb、PLT水平高于对照组(P<0.05);输血24 h后,研究组FIB水平高于对照组,PT、APTT水平低于对照组(P<0.05);输血24 h后,研究组CD4^(+)、CD3^(+)水平高于对照组(P<0.05);输血24 h后,研究组TNF-α、IL-6水平高于对照组(P<0.05)。研究组血容量恢复时间、ICU住院时间短于对照组(P<0.05)。结论与血浆和红细胞比例为1∶2的成分输血相比,血浆和红细胞比例为1∶1的成分输血应用于严重创伤患者中的效果更好,能减少对机体血常规、凝血功能及免疫功能的影响,缩短患者血容量恢复和ICU住院时间,但容易引发炎症反应,需密切关注患者炎症因子水平。

Objective To investigate the effect of the ratio of plasma to red blood cells in the infused blood products on component blood transfusion for severe trauma.Methods The clinical data of 186 patients with severe trauma admitted to the First People’s Hospital of Shangqiu from February 2019 to December 2022 were retrospectively selected.According to the ratio of plasma to red blood cells in the infused blood products,the selected patients were divided into the control group and the study group,with 93 cases in each group.The control group was infused with the blood products with plasma to red blood cells in a 1∶2 ratio,and the study group was infused with the blood products with plasma to red blood cells in a 1∶1 ratio.The blood routine indicators,including hemoglobin(Hb)and platelet count(PLT),coagulation function assessed by fibrinogen(FIB),prothrombin time(PT)and activated partial thromboplastin(APTT),immune function assessed by T cell subsets,including cluster of differentiation 4^(+)(CD4^(+))and cluster of differentiation 3^(+)(CD3^(+)),inflammatory factors,including tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6),and clinical indicators,including volume recovery time and length of intensive care unit(ICU)stay,were compared between the two groups before and 24 hours after transfusion.Results The levels of Hb and PLT in the study group were higher than those in the control group 24 hours after blood transfusion(P<0.05).Compared with the control group,the level of FIB in the study group was higher,and the levels of PT and APTT were lower 24 hours after blood transfusion(P<0.05).Compared with the control group,the levels of CD4^(+)and CD3^(+)in the study group were higher 24 hours after blood transfusion(P<0.05).Compared with the control group,the levels of TNF-αand IL-6 in the study group were higher 24 hours after blood transfusion(P<0.05).Compared with the control group,the blood volume recovery time and the length of ICU stay in the study group were shorter(P<0.05).Conclusions Compared with the component blood transfusion with plasma to red blood cells in a 1∶2 ratio,the component blood transfusion with plasma to red blood cells in a 1∶1 ratio of has a better effect on patients with severe trauma.It can reduce the impact on blood routine,coagulation function and immune function,shorten the recovery time of blood volume and length of ICU stay,but is prone to causing inflammatory response.It is necessary to pay close attention to the levels of inflammatory factors in patients.