不同配比输血方案治疗严重创伤出血的疗效分析  

Comparison of different plasma to packed red blood cell ratios in patients with severe traumatic hemorrhage

作　　者：张更伟 单爱军 王进 钟贤良 龙连宫 钟源波 柳勋法 Zhang Geng - wei Shan Ai -jun Wang Jin Zhong Xian - liang Long Lian - gong Zhong Yuan - bo Liu Xun -fa.(Department of Emergency, Shenzhen People＇s Hospital, Shenzhen 518020, China)

机构地区：[1]深圳市人民医院急诊中心外科,广东深圳518020

出　　处：《中国急救医学》2017年第10期907-911,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的观察新鲜冰冻血浆（fresh frozen plasma，FFP）与红细胞悬液（packed red blood cell，PRBC）的不同配比对严重创伤出血预后的影响，探索合理输血配比。方法回顾性研究严重创伤出血患者150例，分为低配比组（FFP／PRBC≤1：2，51例）、中配比组（1：2〈FFP/PRBC≤1：1，49例）和高配比组（FFP／PRBC〉1：1，50例）；方差分析比较三组24h液体输注量及24h后实验室检查（Hb、PLT、INR、APTT、pH值）；卡方检验比较并发症（感染、输血相关性肺损伤及ARDS）发生率及死亡率（24h、30d）；对不同时点生存率行生存分析。结果三组人院情况差异无统计学意义；低配比组24h内晶体液使用量高于中、高配比组，24h后实验室检查指标差于中、高配比组；与低配比组比较，高配比组感染和输血相关性肺损伤发生率显著升高，而中配比组未见显著升高。生存分析显示，中配比组24h和30d生存率均显著高于低配比组，而高配比组24h生存率虽高于低配比组，但30d生存率差异无统计学意义。结论提高FFP／PRBC配比可以改善输血后实验室检查指标，有利于提高短期生存率（24h），但当配比〉1：1时，则显著增加并发症发生风险，不利于提高远期生存率。因此，推荐输血配比为1：2〈FFP／PRBC≤1：1。Objective To compare the efficacy and safety of different plasma to packed red blood cell ratios in resuscitating patients with severe traumatic hemorrhage. Methods We retrospectively reviewed the medical records of 150 traumatic patients treated with massive transfusions from October 2011 to October 2015. Patients were divided into 3 groups according to the fresh frozen plasma（FFP） ： packed red blood cell （ PRBC ） ratio ： a low - ratio （ FFP/PRBC ≤ 1 ： 2, 51 cases ）, a mediate group（ I： 2 〈 FFP/PRBC ≤ 1 ： 1, 49 cases） and a high - ratio group （ FFP/PRBC 〉 1 ：1, 50 cases）. The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. Results During the first 24 hours, FFP quantities and FFP/PRBC ratios between any two groups were significantly different. To maintain the blood volume, the low-ratio group who were given less FFP, however, required more crystalloids which resulted in a poorer 24 h laboratory values. Infections and transfusion related acute lung injuries were more common in the high - ratio group, and the difference was statistically significant. Kaplan - Meier plots revealed that the 24 h survival rate was significantly higher in the mediate - ratio group（ 81.6% ） and the high - ratio group （82.0%） than the low - ratio group （60.8 % ） （P 〈 0.001 ）. However, the 30 d survival rate in the high - ratio group sharply decreased to 62.0%, which was not significantly different from the low - ratio group（51.0% , P =0. 264）. There was still a significant difference in the 30 d survival rate between the mediate and low-ratio group（75.5% vs. 51.0%, P=0.011）. Conclusion In severe hemorrhagic traumatic patients, as the FFP/PRBC ratio increases, the 24 h laboratory values are improved and the short - term survival rates （ 24 h） increased. However, the risk of transfusion - related complication increases significantly when the FFP/PRBC ratio is raised to 〉 1 ： 1. So, 1

关 键 词：成份输血 创伤 大出血 新鲜冰冻血浆 红细胞悬液 

分 类 号：R457.1[医药卫生—治疗学]