严重创伤患者大量输血时血浆与红细胞输注比例探讨  

Study on plasma-to-red blood cell ratio in patients with severe trauma during mass transfusion

作　　者：堵敏霞[1] 上官志敏[1] 韦俐[1] 屈晨虹 DU Min-xia;SHANG-GUAN Zhi-min;WEI Li(Department of Blood Transfusion,the Third Affiliated Hospital of Changzhou,ChangZhou213000,China)

机构地区：[1]江苏省常州市第一人民医院输血科,213000

出　　处：《中国实用医药》2023年第21期170-173,共4页China Practical Medicine

摘　　要：目的探讨大量输血时血浆与红细胞输注比例对严重创伤患者凝血功能的影响。方法选取135例严重创伤需大量输血患者作为研究对象,按照入院24 h内输入血浆和红细胞的比例分为低比例组(65例,血浆:红细胞=1∶2~1∶1)和高比例组(70例,血浆:红细胞>1∶1)。比较两组血常规和凝血功能指标[血红蛋白(Hb)、红细胞压积(HCT)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)],入院24 h内输血情况,并发症发生情况。结果输血前,两组患者的Hb、HCT、PLT、PT、APTT、FIB水平比较,差异无统计学意义(P>0.05)。输血24 h后,两组患者Hb、HCT、PLT、PT、APTT、FIB水平比较,差异无统计学意义(P>0.05)。输血24 h后,低比例组和高比例组的Hb、HCT、PT、APTT水平与本组输血前比较差异无统计学意义(P>0.05)。输血前,低比例组PLT、FIB分别为(167.63±99.60)×10^(9)/L、(1.72±1.05)g/L,高比例组分别为(142.27±99.41)×10^(9)/L、(1.64±2.01)g/L;输血24 h后,低比例组PLT、FIB分别为(79.89±44.90)×10^(9)/L、(2.27±1.45)g/L,高比例组分别为(66.06±52.01)×10^(9)/L、(2.90±2.28)g/L。输血24 h后,低比例组和高比例组的PLT均明显低于本组输血前,FIB水平均明显高于输血前,差异有统计学意义(P<0.05)。两组入院24 h内输注红细胞量、输注冷沉淀量比较差异无统计学意义(P>0.05);高比例组入院24 h内输注血浆量(21.23±12.92)U显著高于低比例组(12.95±7.89)U,差异具有统计学意义(P<0.05)。高比例组的多脏器功能衰竭发生率22.86%明显高于低比例组的6.15%,差异有统计学意义(P<0.05);两组的感染、凝血功能障碍、急性肾功能不全发生率比较差异无统计学意义(P>0.05)。结论严重创伤患者大量输血时,与低比例血浆输注比较,高比例血浆输注并无很大的优势,推荐比例为1∶2~1∶1,因为过于抬高血浆的比例没有必要。Objective To discuss the effect of plasma-to-red blood cell ratio on coagulation function of patients with severe trauma during mass transfusion.Methods A total of 135 patients with severe trauma requiring massive transfusion were divided into a low-ratio group(65 cases,plasma-to-red blood cell ratio=1∶2-1∶1)and a high-ratio group(70 cases,plasma-to-red blood cell ratio>1∶1)according to plasmato-red blood cell ratio within 24 h after admission.Both groups were compared in terms of blood routine and coagulation function indexes[hemoglobin(Hb),hematocrit(HCT),platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)],blood transfusion within 24 h after admission,and complications.Results Before blood transfusion,there was no statistically significant difference in terms of Hb,HCT,PLT,PT,APTT and FIB levels between the two groups(P>0.05).After 24 h of blood transfusion,there was no statistically significant difference in terms of Hb,HCT,PLT,PT,APTT and FIB levels between the two groups(P>0.05).After 24 h of blood transfusion,the levels of Hb,HCT,PT and APTT in the low-ratio group and the high-ratio group had no statistical significance compared with those before blood transfusion in this group(P>0.05).Before blood transfusion,PLT and FIB were(167.63±99.60)×10^(9)/L and(1.72±1.05)g/L in the lowratio group,and(142.27±99.41)×10^(9)/L and(1.64±2.01)g/L in the high-ratio group,respectively.After 24 h of blood transfusion,PLT and FIB were(79.89±44.90)×10^(9)/L and(2.27±1.45)g/L in the low-ratio group,and(66.06±52.01)×10^(9)/L and(2.90±2.28)g/L in the high-ratio group,respectively.After 24 h of blood transfusion,PLT level in low-ratio group and high-ratio group was significantly lower than that before blood transfusion in this group,and FIB level was significantly higher than that before blood transfusion in this group.The differences were statistically significant(P<0.05).There was no statistically significant difference in the amount of red blood cells transfus

关 键 词：严重创伤 输血 血浆 红细胞 输注比例 

分 类 号：R457.1[医药卫生—治疗学] R641[医药卫生—临床医学]