限制性输血治疗急性上消化道出血的效果及对凝血功能、预后的影响  

Curative effect of restricted blood transfusion and its influences on coagulation function and prognosis in patients with acute upper gastrointestinal bleeding

作　　者：杨洪军[1] 李勇[2] 丁梅 YANG Hongjun;LI Yong;DING Mei(Department of Blood Transfusion,Affiliated Hospital of North Sichuan Medical College,Nanchong Sichuan 637000,China)

机构地区：[1]川北医学院附属医院输血科,四川南充637000 [2]川北医学院附属医院肝胆外二科,四川南充637000 [3]遂宁市第一人民医院检验科,四川遂宁629000

出　　处：《中国急救复苏与灾害医学杂志》2024年第10期1331-1335,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：四川省卫生健康委员会科研课题(编号:20PJ150)。

摘　　要：目的探讨限制性输血治疗急性上消化道出血(AUGIB)的效果及对凝血功能、预后的影响。方法按随机数字表法将2021年5月—2023年10月本院收治的208例AUGIB患者分成对照组(104例)和试验组(104例)。对照组行开放性输血治疗,试验组行限制性输血治疗。比较两组疗效、不同时间点止血率、人均输血量、凝血功能和预后相关指标的差异。结果试验组治疗后的总有效率高于对照组(P<0.05);治疗72 h后,试验组的人均输血量、严重贫血纠正时间、血乳酸、BE值、血红蛋白(Hb)均低于对照组,血小板计数高于对照组(P<0.05);两组收缩压、心率均低于同组治疗前,且试验组低于对照组(P<0.05);两组治疗72h后的部分凝血活酶时间(APTT)、凝血酶原时间(PT)均低于同组治疗前,纤维蛋白原(FIB)、D-二聚体(D-D)高于同组治疗前,且试验组改善程度优于对照组(P<0.05);试验组的住院时间、再出血率均低于对照组(P<0.05),两组病死率无明显差异(P>0.05)。结论限制性输血在AUGIB治疗中疗效显著,能有效维持生命体征平稳及机体代偿平衡,减少输液量,改善凝血功能,降低再出血率,缩短住院时间。Objective To explore the effectiveness of restrictive blood transfusion therapy in the treatment of acute upper gastrointestinal bleeding(AUGIB)and its impact on coagulation function and prognosis.Methods According to random number table method,208 patients with AUGIB admitted to the hospital were divided into control group(104 cases,open blood transfusion)and experimental group(104 cases,restricted blood transfusion)between May 2021 and October 2023.The curative effect,hemostasis rates at different time points,blood transfusion volume per capita,coagulation function and prognostic indexes were compared between the two groups.Results After treatment,total response rate of experimental group was higher than that of control group(P<0.05).After 72 h of treatment,blood transfusion volume per capita,correction time of severe anemia,blood lactic acid,BE value and hemoglobin(Hb)in experimental group were lower than those in control group,while platelet count was higher than that in control group(P<0.05).After treatment,systolic blood pressure and heart rate were decreased in both groups,which were lower in experimental group than control group(P<0.05).After 72 h of treatment,activated partial thromboplastin time(APTT)and prothrombin time(PT)were shortened,fibrinogen(FIB)and D-dimer(D-D)were increased in both groups,and the improvement was better in experimental group(P<0.05).The length of hospital stay and rebleeding rate in experimental group were lower than those in control group(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion Curative effect of restricted blood transfusion is significant in AUGIB,which can effectively maintain stable vital signs and body compensation balance,reduce blood transfusion volume,improve coagulation function,reduce rebleeding rate and shorten hospitalization time.

关 键 词：急性上消化道出血 限制性输血 开放性输血 凝血功能 预后 

分 类 号：R573.2[医药卫生—消化系统] R457.1[医药卫生—内科学]