创伤性失血病人输血前后血细胞比容和酸碱度变化及其与凝血功能的关系分析  

Changes of hematocrit and pH before and after blood transfusion in patients with traumatic hemorrhage and their relationship with coagulation function

作　　者：李双涛[1] 杨京灵[1] 吕红艳[1] 张晶[1] LI Shuang-tao;YANG Jing-ling;L Hong-yan;ZHANG Jing(Department of Blood Transfusion,Beijing Geriatrics Hospital,Beijing 100095,China)

机构地区：[1]北京老年医院输血科,北京100095

出　　处：《蚌埠医学院学报》2023年第7期941-946,共6页Journal of Bengbu Medical College

基　　金：北京市医卫健康公益基金会项目(GXYB-005)。

摘　　要：目的:探讨创伤性失血病人输血前后血细胞比容(HCT)和酸碱度(pH)变化及其与凝血功能的关系。方法:选取创伤性失血病人102例进行前瞻性研究临床实验,采用血凝仪检测各组HCT、pH指标,采用血栓弹力图仪检测凝血反应时间(R)、凝固角(a-Angle)和血栓最大幅度(MA);采用Pearson回归分析检验输血前后的HCT、pH与R、a-Angle、MA值与凝血功能的相关性。结果:输血前,A、B、C组HCT、pH、纤维蛋白原(Fib)、a-Angle值、MA值比较,A组<B组<C组(P<0.05);凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、R值比较,A组>B组>C组(P<0.05);输血后,A、B、C组各凝血指标差异均无统计学意义(P>0.05),且较输血前均有所改善(P<0.05)。输血前,pH、a-Angle值、MA值:D组<E组<F组(P<0.05);PT、TT、APTT、R值:D组>E组>F组;pH值F组<G组,R值F组>G组(P<0.05~P<0.01),F组和G组的a-Angle值、MA值、PT、TT、APTT、R值差异无统计学意义(P>0.05),D、E、F组的Fib值差异均无统计学意义(P>0.01),且均小于G组(P<0.05~P<0.01);输血后D、E、F、G组的pH、Fib、PT、TT、APTT、R值、a-Angle值、MA值差异无统计学意义(P>0.05),且较输血前显著改善,组内比较差异有统计学意义(P<0.05)。HCT、pH水平越高,创伤性失血病人的ICU住院时间、出血时间越短(P<0.05~P<0.01)。Pearson相关分析发现,HCT和pH(<7.45)同PT、TT、APTT、R值、住院时间、出血时间等凝血指标呈负相关关系(P<0.01),同Fib、a-Angle值、MA值等凝血指标呈正相关关系,且HCT、pH在创伤性失血的凝血指标同样呈正相关关系(P<0.01)。结论:创伤性失血病人的凝血功能障碍的严重程度与HCT、pH下降有关,且HCT水平越低,酸中毒的发生率越高、预后越差,故做好输血前后的HCT、pH检测对创伤性失血的临床诊治十分必要,二者也是影响其凝血功能的重要指标。Objective:To investigate the changes of hematocrit(HCT)and pH before and after blood transfusion in patients with traumatic hemorrhage and their relationship with coagulation function.Methods:A total of 102 patients wilh traumatic blood loss were enrolled for the prospective clinical trial.The HCT and pH indexes of each group were detected using coagulometer;the coagulation reaction time(R),coagulation angle(a-Angle),and maximum magnitude of thrombus(MA)were detected using the thromboelastography;the logistic regression analysis was used to analyze the correlation of coagulation function before and after blood transfusion with HCT,pH,R,a-Angle,and MA values.Results:Before blood transfusion,HCT,pH,fibrinogen(Fib),a-Angle value,and MA value of group A,B and C were compared,and the corresponding result was group A<group B<group C(P<0.05);prothrombin time(PT),thrombin time(TT),activated partial thrombopaltin time(APTT),R value were compared,and the result was group A>group B>group C(P<0.05);after blood transfusion,there was no significant difference in coagulation indexes among groups A,B and C(P>0.05),and all indexes were improved compared with those before blood transfusion(P<0.05).Before blood transfusion,pH,a-Angle value,MA value of group D,E and F were compared,and the corresponding result was group D<group E<group F(P<0.05).PT,TT,APTT,R value of group D,E and F were compared,and the corresponding result was group D>group E>group F.pH value of group F and G were compared,and the corresponding result was group F<Group G.R value of group F and G were compared,and the corresponding result was group F>group G(P<0.05 to P<0.01).There was no significant difference in a-Angle value,MA value,PT.TT.APTT,and R value between group F and group G(P>0.05);there was no significant difference in the Fib value among group D,E,F(P>0.01)and the Fib values among group D,E,F were smaller than those in group G(P<0.05 to P<0.01).There was no significant difference in TT,APTT,R values,a-Angle values,and MA values of group D,E,F and gro

关 键 词：创伤性失血 输血 血细胞比容 酸碱度 凝血功能 

分 类 号：R641[医药卫生—外科学]