等比例成分输血治疗多发伤并发创伤性凝血病疗效研究  

Research on the effect of proportional component transfusion therapy on polytrauma combined traumatic coagulopathy

作　　者：崔锐红[1] 李俊杰[1] 陈实[1] 尹文[1] 

机构地区：[1]第四军医大学西京医院急诊科,西安710032

出　　处：《临床急诊杂志》2015年第12期912-916,共5页Journal of Clinical Emergency

基　　金：西京医院学科助推计划(No:XJZT14D10)

摘　　要：目的:探讨损伤控制性复苏(DCR)方案配合等比例成分输血治疗多发伤并发创伤性凝血病(ATC)疗效。方法:选取2014-03-2015-03我院急诊创伤抢救室收治的ATC患者48例,治疗均采用DCR方案,治疗过程中患者输注浓缩红细胞(CRBC)和新鲜冰冻血浆(FFP)剂量不同,把其中CRBC和FFP按照1∶1及2∶1输注的患者进行研究分析。将患者分为2组,A组按照1∶1比例输注,B组按照2∶1输注。回顾分析患者入院后第1、2、3天血红蛋白(Hb)、凝血酶原时间(PT)、国际化标准比率(INR)、纤维蛋白原(FIB)水平、血压、中心静脉压(CVP)水平。结果:2组患者在入院后的第1天的Hb组间比较,差异无统计学意义(P>0.05),第1天与第2、3天Hb之间差异有统计学意义(P<0.05),入院第1天,2组患者的PT、INR、FIB比较,差异无统计学意义(P>0.05),各指标之间在第1天与第2、3天之间的比较差异有统计学意义(P<0.05)。入院后第2、3天A组PT、INR、FIB、血压、CVP优于对照组(P<0.05)。在救治多发伤并发ATC患者时,等比例成分输血可维持相同Hb及血凝目标值而节约红细胞(RBC)的输注,从经济学角度A组较B组人均治疗费少。结论:DCR方案配合等比例成分输血对多发伤并发ATC具有较好疗效。Objective：To investigate the clinical effect of damage control resuscitation（DCR）scheme combined with the blood transfusion with equal ratio component on severe multiple injuries with acute traumatic coagulopathy（ATC）.Method：Patients of emergency trauma emergency-room who had severe multiple injuries with ATC were chosen to make retrospective analysis from March 2104 to March 2015.A total of 48 eligible patients were included and divided into two groups.Patients of group B were treated with the different ratio concentrated red blood cells（CRBC）and fresh frozen plasma（FFP）（CRBC∶FFP=2∶1）,while those of Group A received the equal ratio CRBC and FFP.Hemoglobin（Hb）,Prothrombin time（PT）,International normalized ratio（INR）,Fibrinogen（FIB）,Blood pressure（BP）,Central venous pressure（CVP）were measured on the 1st,2nd,3rd day after admission.Result：Group A and group B after admission of the 1d,there is no significant difference（P〈0.05）between Hb.There exist significant difference between 1dand 2nd,3rd（P〈0.05）;on the first day of admission patients＇ s PT,INR and FIB do not exist significant difference（P〉0.05）;the comparison between each index both exist significant difference between 1dand 2nd,3rd（P〈0.05）;the levels of PT,INR,FIB,BP and CVP of the treatment group A on the 2nd,3rd day after admission were better（P〈0.05）than those of the control group B.Conclusion：Damage control resuscitation scheme combined with the blood transfusion with equal ratio component have a good effect on the patients who suffer in severe multiple injuries with ATC.In the treatment of patients who with multiple injuries and acute traumatic coagulopathy（ATC）,such as proportion of component blood transfusion can maintain the same Hb and PT,INR,FIB and save the RBC infusion,group A less than the average cost of treatment group B from an economic point.

关 键 词：等比例成分输血 多发伤 创伤性凝血病 疗效 

分 类 号：R594.1[医药卫生—内科学]