重症中暑患者在院期间成分输血情况分析  

Blood component transfusion for treatment of 21 severe heatstroke victims

作　　者：周雪莹 欧阳旭 于笑难 ZHOU Xueying;OUYANG Xu;YU Xiaonan(Department ofTransfusion,Northern Theater Conimand General Hospital,Shengyang 110016,China)

机构地区：[1]北部战区总医院输血科,辽宁沈阳110016

出　　处：《中国输血杂志》2020年第2期126-129,共4页Chinese Journal of Blood Transfusion

摘　　要：目的分析重症中暑患者临床资料及住院期间输血情况,为重症中暑患者合理有效输血治疗提供参考。方法对本院自2015年6月-2018年8月期间采用成分输血和/或血浆置换救治的21名重症中暑患者的临床资料特征、部分相关血液检验结果及血液成分输注情况进行回顾性分析。结果本研究共21名患者中,用血时间为3.8±2.86 d,住院天数为27.29±17.04 d。患者中6例输注悬浮红细胞RBC共计52.4 U;20例输注冰冻血浆FP共计35 840 mL,14例输注冷沉淀CRYO共计466 U,10例输注血小板APC共计18个治疗量;3例完成8次血浆置换用量为7 720.00±1 500.20 mL共计23 160 mL。按21例输血情况计算4种血液成分的输注量分别为RBC:2.50±6.28 U,FP:1 706.67±1 240.68 mL,CRYO:22.19±21.62 U,APC:0.86±1.08个治疗量。3名行血浆置换患者,置换后血清丙氨酸氨基转移酶ALT、血清天门冬氨酸氨基转移酶AST两项指标均明显降低;血清总胆红素TBil、血清直接胆红素DBil两项指标变化趋势没有特异性差别。1名患者在血栓弹力图检测结果指导下进行成分输血,凝血功能得到及时纠正。结论输血科在密切关注重症中暑患者病情、积极配合临床治疗、保证供血的及时有效的同时,血栓弹力图(TEG)检测在成分输血时机及种类选择上可提供指导作用。Objective To analyze the clinical data of 21 patients who had been hospitalized for severe heat stroke(HS) and the blood component transfusion during hospitalization, so as to provide references for reasonable and effective transfusion therapy for patients with severe HS. Methods The hospitalization records, including the results of some related blood tests, types and volumes of blood component transfused, of 21 patients with severe HS treated by blood component transfusion and/or plasma exchange from June 2015 to August 2018 were analyzed retrospectively.Results A total of 21 patients in this study received transfusion for 3.8±2.86 days and were hospitalized for 27.29±17.04 days. Six patients infused red cells(52.4 U);20 patients infused FP(35 840 mL), 14 patients infused CRYO(466 U), and 10 patients infused APC(18 therapeutic doses).Three patients completed 8 times of plasma exchange with a total dose of 23 160 mL[at mean of(7 720.00±1 500.20) mL]. The mean volumes of four blood components transfused in 21 patients were RBC in(2.50±6.28)U, FP in(1 706.67±1 240.68)mL, CRYO in(22.19±21.62)U, and APC in(0.86±1.08) therapeutic dose. In 3 patients underwent plasma exchange, ALT and AST decreased significantly after treatment;the trend of serum total bilirubin(TBil) and serum direct bilirubin(DBil) remained relatively unchanged. One patient underwent blood component transfusion when thromboelastography was used, and the coagulation function was corrected in time. Conclusion Severe HS patients should be closely monitored,clinical treatments and blood transfusion should be supplied promptly to improve the prognosis. TEG may be an effective additional means of treating HS as it can provide guidance in the selection of timing and types of component transfusion.

关 键 词：重症中暑 热射病 成分输血 血浆置换 血栓弹力图 

分 类 号：R473.5[医药卫生—护理学] R457.14[医药卫生—临床医学]