新鲜冰冻血浆、冷沉淀和血小板在抢救并发凝血功能障碍产后出血中的作用分析  

Analysis of the role of fresh frozen plasma,cold precipitation and platelet in the treatment of postpartum hemorrhage with coagulation disfunction complication

作　　者：许靖[1] 高利臣[2] 饶丽娟[3] 粟艳林[3] 

机构地区：[1]湖南省长沙市中心医院输血科,湖南长沙410004 [2]湖南省长沙市中心医院药学部,湖南长沙410004 [3]湖南省长沙市中心医院妇产科,湖南长沙410004

出　　处：《中国输血杂志》2016年第6期626-629,共4页Chinese Journal of Blood Transfusion

摘　　要：目的分析新鲜冰冻血浆、冷沉淀和血小板(Plt)在抢救并发凝血功能障碍的产后出血病例中所发挥的作用。方法根据入组及排除标准,回顾性收集本院2012年11月-2015年7月全部17例伴有凝血功能障碍的产后出血病例。通过对产前、抢救前及抢救成功后2 h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和Plt计数的分析,判断导致凝血功能障碍所缺乏的主要凝血成分,同时分析各类血液成分输注在修复凝血功能方面所发挥的作用。入组研究的17例患者,输注红细胞制品17例,输注新鲜冰冻血浆15例,输注冷沉淀13例,输注血小板8例。红细胞、新鲜冰冻血浆、冷沉淀均在抢救早期进行输注,血小板输注时间相对滞后。结果入组病例抢救前PT、APTT、FIB和Plt数值均较产前有改变。抢救前APTT延长达到输血临界值(参考区间中值1.5倍)的有13例,其明显高于Plt降低至输血临界值(<50×109/L)的2例(P<0.001);抢救前与抢救成功后2 h凝血相关指标对比分析显示,反映凝血因子指标的APTT和FIB变化分别有统计学差异(t=4.09,P<0.01;t=5.88,P<0.01;),而Plt无统计学差异(t=1.28,P=0.22)。结论产后凝血功能障碍主要是因凝血因子消耗性缺乏所致。及早输入足量含有各类凝血因子的新鲜冰冻血浆或冷沉淀,是重建凝血功能的关键。Objective To analyze the role of fresh frozen plasma,cold precipitates and platelet in the treatment of postpartum hemorrhage with coagulation dysfunction complication. Method According to the inclusion and exclusion criteria,all postpartum hemorrhage cases complicated with coagulation dysfunction were retrospectively collected in our hospital from November 2012 to July 2015. The prothrombin time（ PT）,activated thromboplastin time（ APTT）,fibrinogen（ FIB）,the changes in platelet number（ Plt） were analyzed in patients at prenatal stage,bleeding,and 2 hours after successful rescue.The roles of various blood component transfusion in the repair of the coagulation function were analyzed. In all 17 patients,17 cases were transfused with red blood cell products,15 cases with plasma,13 cases with cold precipitates,and 8 cases with platelet. Red blood cells,plasma and cold precipitates were transfused in the early stage of treatment,while platelet transfusion was relatively delayed. Results The levels of PT,FIB,P,HB and APTT changed when bleeding occurred. The cases with prolonged APTT to transfusion threshold（ 1. 5 fold of reference median） were significantly more than those with Plt reached to transfusion threshold（ 〈50 × 10^9/ L）（ P〈0. 001）. When coagulation- related indicators were found between pre- transfusion and 2 hours after transfusion,coagulation factor- related APTT and FIB changed significantly（ t = 4. 09,P〈0. 01; t = 5. 88,P〈0. 01; respectively）. However,Plt did not change significantly（ t = 1. 28,P = 0. 22）. Conclusion For the treatment of postpartum hemorrhage with coagulation dysfunction,the recovery of the function of coagulation factors has relative important clinical significance. Therefore,early transfusion of adequate plasma or cold precipitation to supply coagulation factor to improve the coagulation function,is one of the key factors for the success of treatment of postpartum hemorrhage.

关 键 词：凝血功能障碍 产后出血 成分输血 抢救 治疗 

分 类 号：R457.11[医药卫生—治疗学]