血浆和红细胞不同输注比率在重型颅脑损伤合并严重多发伤救治中的疗效观察  

Therapeutic effects of different ratio between fresh frozen plasma and red blood cell transfusions in severe multiple injuries patients with traumatic brain injury

作　　者：田万管[1] 张文涛[1] 朱志宏[1] 黎檀实[1] 

机构地区：[1]解放军总医院急诊科,北京100853

出　　处：《创伤外科杂志》2013年第1期15-18,共4页Journal of Traumatic Surgery

摘　　要：目的探讨给予不同的新鲜冰冻血浆和红细胞输注比率对救治重型颅脑损伤合并严重多发伤的临床疗效。方法回顾性分析我院急诊科2001年1月～2010年12月救治的420例严重多发伤需要大量液体复苏患者的临床资料,分为合并颅脑损伤组(206例)和无颅脑损伤组(214例),根据给予新鲜冰冻血浆(FFP)和红细胞(RBC)的比率,再分为高比率组(FFP∶RBC>1∶2)和低比率组(FFP∶RBC≤1∶2)。比较两组患者病死率,脓毒血症、多器官功能障碍综合征(MODS)的发生率,以及脱机时间、ICU治疗时间和住院时间。结果不论是否合并有颅脑损伤,高比率组的病死率低于低比率组,有统计学意义(P<0.001);合并颅脑损伤的高比率组脓毒症的发生率较高(P<0.05),其他各组脓毒症和多器官功能衰竭的发生率没有差别;高比率组和低比率组的脱机时间、ICU治疗时间、住院时间有明显差别,但是在存活患者中,两组没有差别。结论重型颅脑损伤合并严重多发伤需要大量液体复苏的患者,早期液体复苏给予高比率的FFP和RBC可以降低死亡率。Objective To discuss the clinical effect of different ratios between fresh frozen plasma （ FFP ） and red blood cell （ RBC ） transfusions in treating severe multiple injuries patients with traumatic brain injury. Methods Totally 420 patients with severe multiple injury requiring massive transfusion from Jan. 2001 to Dec. 2010 were divided into two groups based on whether accompanied with traumatic brain injury（TBI） （206 cases with TBI,214 cases without TBI）. According to the transfusion ratio between plasma and red blood cell they had received during initial massive transfusion, patients were subdivided into high ratio group （ FFP ： RBC 〉 1 ： 2 ） and low ratio group（FFP ： RBC ≤ 1：2） respectively. Patients＇ mortality, incidence of sepsis and multiple organs dysfunction syndrome （MODS） ,ventilator-free days,length of ICU stay and length of stay in hospital between groups were compared, respectively. Results The mortality was statistically lower in the high ratio group regardless of the pres- ence or absence of TBI（ P 〈0.001 ）. The frequency of sepsis and multiple organ failure did not differ among groups except for sepsis in patients with TBI transfused with a high ratio （P 〈 0.05）. Ventilator-free days, length of ICU stay and hospital stay differed significantly between high and low ratio groups but not when analyzed for survivors on- ly. Conclusion The high FFP：RBC ratio transfusion can significantly decrease the death rate during early fluid resuscitation in severely injured patients both with and without traumatic brain injury.

关 键 词：多发伤 颅脑损伤 血浆 红细胞 复苏 

分 类 号：R651.15[医药卫生—外科学]