某医院近5年肝硬化患者冰冻血浆输注回顾性调查分析  

Usage of frozen plasma in patients with liver cirrhosis: a retrospective study

作　　者：武世文[1] 孙桂香[1] 滕方[1] 卢尧[1] 程芝灵 刘敏[1] 周晶[1] 张有翠 蒋远萍 陈伟[1] 文爱清[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所输血科,重庆400042 [2]重庆医科大学检验医学院,重庆400016

出　　处：《第三军医大学学报》2014年第4期398-401,共4页Journal of Third Military Medical University

摘　　要：目的调查分析某医院近5年肝硬化患者临床资料，重点探讨冰冻血浆（frozen plasma, FP）使用现状。方法收集某医院2008年7月至2013年6月所有肝硬化住院患者的病历资料，对FP的输注原因、不同Child-Pugh分级患者FP使用情况以及输注FP前后凝血指标的变化等进行统计分析。结果共纳入肝硬化患者1 511例，其中输注FP者408例（27.0%），主要为乙型病毒性肝炎肝硬化，其次为酒精性和胆汁淤积性。408例患者共接受2 708次FP治疗，合计输注693 800 mL，每例的输注次数和输注量的中位数分别为5次和1 200 mL。首次输注FP的主要原因为改善凝血功能、支持治疗和预防性输注，分别占51.7%、30.9%和8.8%。Child-Pugh分级为C级的患者FP每例的输注量和输注次数均高于A级和B级（P〈0.01）。输注FP前PT主要集中于12.1～20 s（72%），APTT主要集中于30.1～46 s（62%）。INR≤1.4的患者接受FP输注后INR未见缩短，而INR＞1.8者则明显缩短。结论肝硬化患者输注FP的比例和频次均较高，可能存在一定不合理现象。肝硬化患者FP输注指征有待进一步循证学研究。Objective To investigate the clinical data of the current usage of frozen plasma （FP） in liver cirrhosis patients, and to give supportive evidence to the instruction of clinical blood transfusion.Methods The clinical information of demography, diagnosis and FP transfusion in all liver cirrhosis patients who admitted in Daping Hospital from July 2008 to June 2013 was collected. The indication of FP transfusion, FP usage according to different Child-Pugh grades, and the changes of coagulopathy parameters were analyzed. Results A total of 1 511 liver cirrhosis patients （mainly viral hepatitis B, alcoholic and cholestatic liver cirrhosis） were included and 408 cases （27.0%） underwent FP transfusion. Totally 2 708 FP infusions were given to these patients, with a total volume of 693 800 mL. The median transfusion frequency and volume for each patient were 5 times and 1 200 mL, respectively. The main indications of FP in the first infusion were coagulation improvement, support treatment and prophylactic infusion, which accounted for 51.7%, 30.9% and 8.8%, respectively. The median transfusion frequency and volume in Child-Pugh C liver cirrhosis patients were higher than that of Child-Pugh A and B patients. Patients of 72% were transfused with FP for a pretransfusion prothrombin time （PT） between 12.1 and 20 seconds, while 62 percent for the activated partial thromboplastin time （APTT） between 30.1 and 46 seconds. The coagulation status of patients with INR not greater than 1.4 was not improved according to INR parameter after transfusion, whereas that of patients with INR above 1.8 was improved （with the decrease of INR）.Conclusion The proportion and frequency of FP transfusion in liver cirrhosis patients were high, which may be unreasonable. Further evidence-based clinical investigation needs to be done for studying the indication of FP transfusion for liver cirrhosis patients.

关 键 词：肝硬化 冰冻血浆 回顾性调查 

分 类 号：R575.2[医药卫生—消化系统]