早期干预凝血策略在严重创伤大量输血患者中的应用价值  

Application value of early intervention coagulation strategy in massive transfusion patients with severe trauma

作　　者：李秀丹 黄明礼[1] 钱骏[2] 廖群芬 杨天星 曾娅莉[4] LI Xiudan;HUANG Mingli;QIAN Jun;LIAO Qunfen;YANG Tianxing;ZENG Yali(Intensive Medicine Department, Mianyang 404 Hospital, Sichuan Proviunce, Mianyang 621000,China;Intensive Medicine Department, Jiangyou People's Hospital, Sichuan Province, Jiangyou 621000,China;Intensive Medicine Department, Sichuan Science City Hospital, Sichuan Province, Mianyang 621000,China;Blood Transfusion Department, Mianyang 404 Hospital, Mianyang 404 Hospital, Sichuan Province, Mianyang 621000,China)

机构地区：[1]四川绵阳四○四医院重症医学科,四川绵阳621000 [2]四川江油市人民医院重症医学科,四川江油621000 [3]四川省科学城医院重症医学科,四川绵阳621000 [4]四川绵阳四○四医院输血科,四川绵阳621000

出　　处：《中国医药导报》2019年第16期104-107,共4页China Medical Herald

基　　金：四川省绵阳市应用技术研究与开发项目(15S-01-8)

摘　　要：目的探讨早期干预凝血策略在严重创伤大量输血患者中的应用价值。方法选取2017年3月~2018年3月在四川绵阳四○四医院(以下简称“我院”)行早期干预凝血策略期间44例严重创伤需大量输血患者为研究组;选取2016年2月~2017年2月在我院行常规输血策略期间44例严重创伤需大量输血患者为对照组。比较两组急性呼吸窘迫综合征(ARDS)发生率、死亡率及血气分析、凝血功能。结果干预后,研究组ARDS发生率、死亡率均低于对照组(P <0.05);输血后1、5 d,研究组pH、动脉血氧分压(PaO2)均高于对照组,二氧化碳分压(PaCO2)低于对照组(P <0.05);输血后1 d,研究组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均低于对照组,纤维蛋白原(FIB)、血小板计数(PLT)高于对照组(P <0.05);输血后5 d,研究组PT、TT、FIB、PLT均高于对照组,APTT低于对照组(P <0.05)。结论严重创伤大量输血患者行早期干预凝血策略,可降低ARDS发生率及死亡率,改善血气分析,减轻对凝血功能的影响。Objective To explore the application value of early intervention coagulation strategy in patients with massive transfusion after severe trauma. Methods From March 2017 to March 2018, 44 patients with severe trauma requiring massive blood transfusion during the period of early intervention coagulation strategy in Mianyang 404 Hospital of Sichuan ("our hospital" for short) were selected as the research group, 44 patients with severe trauma requiring massive blood transfusion during the period of routine blood transfusion in our hospital from February 2016 to February 2017 were selected as the control group. The incidence, mortality, blood gas analysis and coagulation function of acute respiratory distress syndrome (ARDS) were compared between the two groups. Results After the intervention, the incidence and mortality of ARDS in the study group were lower than those in the control group (P < 0.05);1 and 5 days after transfusion, pH and partial arterial oxygen pressure (PaO2) in the study group were higher than those in the control group, and partial carbon dioxide pressure (PaCO2) were lower than those in the control group (P < 0.05);1 d after transfusion, Prothrombin time (PT), activation time of partial thrombin (APTT) and thrombin time (TT) were all lower in the study group than in the control group, while fibrinogen (FIB) and platelet count (PLT) were higher in the study group than in the control group (P < 0.05);5 d after transfusion, PT, TT, FIB and PLT in the study group were all higher than those in the control group, and APTT was lower than that in the control group (P < 0.05). Conclusion Early intervention of coagulation strategy in patients with severe trauma and massive transfusion can reduce the incidence and mortality of ARDS, improve blood gas analysis, and reduce the impact on coagulation function.

关 键 词：严重创伤 大量输血 急性呼吸窘迫综合征 早期干预凝血策略 

分 类 号：R641[医药卫生—外科学]