不同SRBS︰FFP配比输注对急性创伤大出血患者凝血功能的影响  

Effect of Infusion with Different RBCS: FFP Ratio on Coagulation Function in Patients with Acute Massive Traumatic Hemorrhage

作　　者：余海燕[1] 肖鑫[2] 张黎 黄于庭 YU Haiyan;XIAO Xin;ZHANG Li;HUANG Yuting(Department of Blood Transfusion,Chaohu Hospital,Anhui Medical University,Hefei,Anhui 238000,China;Department of Medical Oncology,Chaohu Hospital,Anhui Medical University,Hefei,Anhui 238000,China;Center for Disease Prevention and Control of Jiangsu Province,Suzhou,Jiangsu 215008,China)

机构地区：[1]安徽医科大学附属巢湖医院输血科,合肥238000 [2]安徽医科大学附属巢湖医院肿瘤内科,合肥238000 [3]江苏省疾病控制中心,江苏苏州215008

出　　处：《临床误诊误治》2023年第9期38-42,共5页Clinical Misdiagnosis & Mistherapy

基　　金：江苏省科技项目(BE2020720);安徽省高等学校科学研究项目(2022AH050791)。

摘　　要：目的 探讨不同悬浮红细胞(SRBC)︰新鲜冰冻血浆(FFP)配比输注对急性创伤大出血患者凝血功能的影响。方法 选取2019年6月—2023年2月收治的急性创伤大出血100例,按输血治疗SRBS︰FFP配比进行分组,其中SRBS︰FFP≥2︰1为A组(32例)、SRBS︰FFP<2︰1~1︰1为B组(35例)、SRBS︰FFP<1︰1为C组(33例),比较3组血液制品输注量、输血前后血常规与凝血指标变化。结果 C组FFP输注量高于B组,B组高于A组(P<0.05)。输血后3组血红蛋白(Hb)均比输血前升高(P<0.05),A组输血后血小板(PLT)明显降低(P<0.05),B组、C组PLT与输血前比较差异无统计学意义(P>0.05);输血后B组、C组Hb、PLT高于A组(P<0.05),但B组与C组比较无明显差异(P>0.05)。输血后A组凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)明显延长,D-二聚体(D-D)、国际标准化比值(INR)明显升高,纤维蛋白原(FIB)明显降低(P<0.05),B组、C组与输血前比较差异无统计学意义(P>0.05)。输血后B组、C组TT、PT、APTT、D-D、INR短于或低于A组,FIB高于A组(P<0.01),但B组与C组比较无明显差异(P>0.05)。结论 SRBS︰FFP<2︰1~1︰1为急性创伤大出血患者输血治疗的适宜配比,有助于防止输血治疗后凝血功能异常,同时可节约血液制品用量。Objective To investigate the effects of infusion with different suspended red blood cells(SRBC):fresh frozen plasma(FFP)ratio on coagulation function in patients with acute massive traumatic hemorrhage.Methods In total,100 patients with acute traumatic hemorrhage admitted from June 2019 to February 2023 were divided into different groups according to the SRBS︰FFP ratio of transfusion therapy,including group A(SRBS︰FFP≥2︰1,n=32),group B(SRBS︰FFP<2︰1-1︰1,n=35),and group C(RBCS︰FFP<1︰1,n=33).The blood product infusion volume,and changes in blood routine and coagulation indexes before and after transfusion were compared among the three groups.Results The FFP infusion volume in group C was higher than that in group B,and higher in group B than in group A(P<0.05).After blood transfusion,hemoglobin(Hb)of the three groups was higher than that before blood transfusion(P<0.05),while platelet(PLT)of the three groups was significantly decreased after blood transfusion(P<0.05);there was no statistical significance in PLT in groups B and C compared with that before blood transfusion(P>0.05).After blood transfusion,Hb and PLT in groups B and C were higher than those in group A(P<0.05),but there was no significant difference between group B and group C(P>0.05).After blood transfusion,thrombin time(TT),prothrombin time(PT)and activated partial thromboplastin time(APTT)in group A were significantly prolonged,D-dimer(D-D)and international normalized ratio(INR)were significantly increased,and fibrinogen(FIB)was significantly decreased(P<0.05).There was no significant difference between group B and group C before transfusion(P>0.05).After blood transfusion,TT,PT,APTT,D-D and INR in groups B and C were short or lower than those in group A,while FIB was higher than that in group A(P<0.01),but there was no significant difference between group B and group C(P>0.05).Conclusion SRBS︰FFP<2︰1-1︰1 is an appropriate ratio for the treatment of acute massive traumatic hemorrhage,which can help to prevent coagulation dysfu

关 键 词：出血 创伤和损伤 悬浮红细胞 新鲜冰冻血浆 输血 配比 凝血酶时间 纤维蛋白原 

分 类 号：R442.7[医药卫生—诊断学]