急症创伤大量输血患者血液指标及凝血状态研究

Study on blood index and coagulation status of patients with massive blood transfusion due to acute trauma

  • 摘要:
      目的  探讨急症创伤大量输血患者的血液指标及凝血状态变化情况。
      方法  选取98例急症创伤需大量输血患者(均需输注大于8 U的红细胞)作为研究对象,将入院24 h内输注悬浮红细胞: 血浆比例为1∶ 1的患者设为A组,将比例为1.5∶ 1的患者设为B组,将比例为2∶ 1的患者设为C组。对所有患者输血前后凝血指标、血液指标等进行检测,比较3组患者血液指标和凝血指标的变化情况。
      结果  与输血前比较, 3组患者大量输血后的凝血活酶时间(APTT)、凝血酶原时间(PT)延长,纤维蛋白原(FIB)水平降低,差异均有统计学意义(P < 0.05); 输血后, A组、B组的APTT、PT、FIB水平比较,差异无统计学意义(P>0.05), C组的APTT、PT水平高于A组、B组, FIB水平低于A组、B组,差异有统计学意义(P < 0.05)。与输血前比较, 3组患者大量输血后的血小板计数(PLT)水平降低,血红蛋白(Hb)、红细胞压积(HCT)水平升高,差异均有统计学意义(P < 0.05); 输血后, A组、B组的PLT、Hb、HCT水平比较,差异无统计学意义(P>0.05), C组的PLT水平低于A组,差异有统计学意义(P < 0.05)。
      结论  大量悬浮红细胞的输注会明显造成患者凝血功能障碍,建议输血时悬浮红细胞:血浆为1∶ 1或1.5∶ 1, 且在输血前后密切监测患者的血液指标及凝血状态,及时补充血小板等成分,以提升救治成功率。

     

    Abstract:
      Objective  To study the changes of blood index and coagulation status in patients with massive blood transfusion due to acute trauma.
      Methods  A total of 98 patients(all requiring more than 8 U red cells) with acute trauma treated in our hospital were enrolled in this study. The patients with a ratio of 1 to 1 at 24 h of admission(suspended erythrocyte to plasma) were included in the group A, and those with a ratio of 1.5 to 1 were as group B, and the those with a ratio of 2 to 1 were in the group C. Blood coagulation function and blood index were measured before and after blood transfusion in all patients, and the changes of above indicators of the two groups were observed and compared.
      Results  Compared with transfusion before, the activated partial thromboplastin time(APTT) and prothrombin time (PT) of three groups after massive transfusion were prolonged, the FIB level was decreased, and the differences were statistically significant (P < 0.05); the APTT, PT and fibrinogen (FIB) levels of group A and group B showed no significant differences (P>0.05), but the APTT and PT levels of group C were higher and the FIB level was lower than group A and group B (P < 0.05). Compared with before transfusion, blood platelet count (PLT) of the three groups was reduced, hemoglobin (Hb) and hematocrit (HCT) were significantly increased (P < 0.05). There were no significant differences in PLT, Hb, HCT levels between group A and group B(P>0.05). PLT level in group C was significant lower than group A (P < 0.05).
      Conclusion  Massive transfusion of suspended red blood cells can cause disorder of coagulation function, so it is suggested to maintain ratio of 1 to 1 or 1.5 to 1(suspended erythrocyte to plasma), and strengthen the detection of coagulation function and timely supplement missed platelets in the treatment of patients with massive trauma to improve the success rate of treatment.

     

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