创伤失血性休克患者临床输血的疗效分析  

The Curative Effect Analysis of Clinical Transfusion in Trauma Patients with Uncontrolled Hemorrhagic Shock

作　　者：胡文静[1] 林振平[2] 鲍晶晶[1] 刘其中[1] 蔡旭兵[1] 

机构地区：[1]南京红十字血液中心,南京210003 [2]南京医科大学,南京210000

出　　处：《医学综述》2014年第21期3964-3965,共2页Medical Recapitulate

基　　金：江苏省自然科学基金(BK2012529);南京市医药卫生科研课题(YKK12159);教育部人文社会科学青年基金(11YJC630120)

摘　　要：目的 探讨意外创伤时临床输血量与疗效的相关性及其在临床治疗中的意义.方法 选择2012年1月至2012年6月南京市属15家医院收治的创伤失血性休克患者214例,根据用血量分为3组：4 h内红细胞用量4～10 U为中等量输血组;4 h内红细胞用量≥10 U、24h内红细胞用量＜20U为大量输血组;24 h内红细胞用量≥20 U为超大量输血组,分析并比较各组血常规及凝血象变化.结果 各组患者血小板计数、活化部分凝血酶原时间（APTT）、凝血酶原时间（PT）比较差异均有统计学意义（P＜0.05）.输血小板组APTT和PT均低于未输血小板组,差异有统计学意义（P＜0.05）.结论 机体损伤越严重,失血量越大,凝血象异常也越明显.若早期使用新鲜冰冻血浆（冷沉淀）及血小板治疗,有助于改善凝血状况.Objective To explore the correlation of clinical blood transfusion amount and curative effect in the accidental trauma, and the clinical significance of blood transfusion. Methods The study included 214 trauma patients with uncontrolled hemorrhagic shock from 15 different hospitals in Nanjing, between January and June in 2012, which were divided into 3 groups according clinical blood transfusion amount, setting erythrocyte usage 4-10 U in 4 hours as moderate amount blood transfusion group;erythrocyte usage ≥ 10 U in 4 hours but 〈20 U in 24 hours as massive blood transfusion group;erythrocyte usage ≥20 U in 24 hours as supersize blood transfusion group, and the change of blood routine and coagulation were analyzed and compared. Results The platelet count, activated partial thromboplastin time （ APTT）, prothrombin time （PT） of each group showed no significant differences（ P 〈0.05 ）. The APTT and PT of platelet transfusion group were lower than those of non-platelet transfusion group, the difference was statistically significant（ P 〈 0.05 ）. Conclusion The more serious the damage and greater the bleeding volume are, the more obvious the disturbance of blood coagulation is. The application of fresh frozen plasma（cryoprecipitate） and platelet in early stage helps to improved blood coagulation condition.

关 键 词：失血性休克 大量输血 凝血象 

分 类 号：R457.1[医药卫生—治疗学]