外科手术大量成分输血对凝血功能的影响(附16例分析)  

Effect of Massive Apheresis on Blood Clotting Function for 16 Patients Undergoing Surgery

作　　者：张蓉[1] 蒋学兵[1] 李文静[1] 王燕菊[1] 陈丽[1] 

机构地区：[1]海军总医院输血科,北京100048

出　　处：《临床误诊误治》2012年第5期58-60,共3页Clinical Misdiagnosis & Mistherapy

基　　金：军队"十二五"重点课题(BHJC005)

摘　　要：目的探讨成分输血在大量输血中的合理应用,以提高临床输血安全性。方法回顾性分析我院2011年1～12月手术大量输血(>5000 ml)16例的临床资料,输血前后检测凝血功能,并统计输血剂量和血液制品种类。结果 16例中13例术前凝血功能正常,3例行肝移植术由于肝脏功能异常导致术前凝血功能差。16例平均输血(6404.38±1973.60)ml,其中输注红细胞悬液平均(17.75±6.95)单位,冰冻血浆平均(25.63±7.67)单位,机采血小板平均(1.31±1.25)单位。输血后8 h与输血前比较,16例凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)均延长,而纤维蛋白原(FIB)和血小板水平皆下降,差异均具有统计学意义(P<0.05)。结论外科手术大量输血会导致患者凝血功能紊乱,临床医生应根据实际病情需要和实验室检查结果合理选择各种血液成分,以减轻大量输血带来的不良后果,加强手术安全性。Objective To summarize the reasonable application in massive transfusion by apheresis in order to improve the clinical transfusion safety.Methods A retrospective analysis was performed on clinical data of 16 patients with massive transfusion(>5000 ml) during operations during January 2011 and December 2011,the blood coltting function was detected,and the dosage and species of blood transfusion before and after a blood transfusion were counted.Results The blood clotting of 13 cases in 16 cases were normal before operation.3 cases were abnormal due to liver dysfunction.Blood transfusion average of intraoperative and postoperation were(6404.38±1973.60) ml.The erythrocyte suspension average was(17.75± 6.95) units,refrigerated plasma average was(25.63 ±7.67) units,blood platelets average was(1.31± 1.25) units.8 h after transfusion,the prothrombin time and activated partial thromboplastin time of 16 cases were prolonged and the fibrinogen,blood platetets of 16 cases decreased when compared with that before blood transfusion,the results had statistical significance(P <0.05).Conclusion Patients may suffer from blood clotting functional disorder in massive transfusion,and physicians should be careful in choosing blood composition according to pathogenetic condition and the results of laboratory examinton,in order to reduce adverse rections and improve safety of surgical safety.

关 键 词：血液成分输血 外科手术 

分 类 号：R457.1[医药卫生—治疗学]