纤维蛋白原作为预防性输注新鲜冰冻血浆指征的意义及阈值初探  

Fibrinogen as an indicator for prophylactic fresh frozen plasma transfusion:Significance and initial exploration

作　　者：刘烁 范明亮 郑燕杰 龚征华 葛聪纬 叶美芬 LIU ShuoFAN Mingliang;ZHENG Yanjie;GONG Zhenghua;GE Congwei;YEMeifen(Department of Blood Transfusion,Lishui Central Hospital,Lishui,323000,China;Department of Laboratory Medicine,Second Hospital of Yinzhou District;Department of Blood Transfusion,Second Hospital of Yinzhou District)

机构地区：[1]丽水市中心医院输血科,浙江丽水323000 [2]宁波市鄞州区第二医院检验科 [3]宁波市鄞州区第二医院输血科

出　　处：《临床血液学杂志》2024年第12期898-900,904,共4页Journal of Clinical Hematology

摘　　要：目的:探讨纤维蛋白原(fibrinogen,Fib)作为预防性输注新鲜冰冻血浆(fresh frozen plasma,FFP)指征的意义及阈值初探。方法:用生理盐水稀释正常对照血浆,检测并观察随着Fib降低,凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)的变化规律。对2020年1月1日—2022年11月30日因出血性疾病导致Fib≤1.80 g/L的4708份凝血检测报告回顾性分析,观察随着Fib降低PT、APTT的变化规律。观察输注FFP改善凝血功能的50例患者输注前后PT、APTT、Fib的变化。结果:随着正常对照血浆的不断稀释或出血性患者出血量的增多,Fib逐渐降低,对应PT、APTT不断延长,当Fib≥1.20 g/L时PT、APTT的延长速度缓慢,当Fib<1.20 g/L时PT、APTT的延长速度明显增快。当出血性患者Fib<1.00 g/L时,PT与APTT均出现了明确的输注FFP指征。输注FFP可以明显提高Fib。结论:出血性或有出血高风险侵入性操作患者,当Fib<1.20 g/L时,即使PT、APTT正常,也建议预防性输注足量FFP,提早改善患者凝血功能,提高Fib,从而减小出血的风险。Objective:To explore the significance and threshold of fibrinogen(Fib)as an indication for prophylactic(fresh frozen plasma,FFP)transfusion.Methods:Normal control plasma was diluted with physiological saline,and the changes in prothrombin time(PT)and activated partial thromboplastin time(APTT)with decreasing Fib were observed.A retrospective analysis was conducted on 4708 coagulation test reports from January 1,2020 to November 30,2022 in patients with bleeding disorders leading to Fib≤1.80 g/L to observe the changes in PT and APTT with decreasing Fib.Fifty patients who received FFP transfusion to improve coagulation function from January 1,2022 to November 30,2022 were retrospectively analyzed to observe the changes in PT,APTT,and Fib before and after transfusion.Results:With the continuous dilution of normal control plasma or increasing bleeding in patients with bleeding disorders,Fib gradually decreased,and PT and APTT prolonged.When Fib≥1.20 g/L,the prolongation of PT and APTT was slow,whereas when Fib<1.20 g/L,the prolongation of PT and APTT increased significantly.When Fib was below 1.00 g/L in patients with bleeding disorders,clear indications for FFP transfusion were observed in both PT and APTT.Infusing FFP can significantly improve Fib.Conclusion:For patients with bleeding disorders or those undergoing invasive procedures at a high risk of bleeding,even when PT and APTT are normal,prophylactic FFP transfusion is recommended when Fib<1.20 g/L to improve coagulation function and raise Fib levels,thus reducing the risk of bleeding.

关 键 词：纤维蛋白原 输注指征 凝血酶原时间 活化部分凝血活酶时间 新鲜冰冻血浆 

分 类 号：R457.1[医药卫生—治疗学]