高原高寒地区大量输血患者血液管理策略 ——附1例报道并文献复习  

Blood management strategy for massive transfusion patients in frigid plateau region:a case report and literature review

作　　者：王海莹 张进进[1] 陈立力 孙晓丽[1] 魏翠 黄永莉 朱迎春 陈冲 邢颜超[1] WANG Haiying;ZHANG Jinjin;CHEN Lili;SUN Xiaoli;WEI Cui;HUANG Yongli;ZHU Yingchun;CHEN Chong;XING Yanchao(Department of Blood Transfusion,Xinjiang Military General Hospital,Urumqi 830002,China)

机构地区：[1]新疆军区总医院输血科,新疆乌鲁木齐830002

出　　处：《中国输血杂志》2025年第2期268-273,共6页Chinese Journal of Blood Transfusion

摘　　要：目的 探讨高原高寒地区大量输血患者的血液管理策略(patient blood management, PBM)。方法 分析1例高原高寒地区肝破裂患者大量输血的救治过程,结合输血难点及文献内容复习,探讨高原高寒地区大量输血患者的PBM。结果 患者术前血常规检测:红细胞(red blood cell, RBC)计数3.14×10^(12)/L,血红蛋白(hemoglobin, Hb)10^(6) g/L,血细胞比容(hematocrit, HCT)30.40%,PLT计数115.00×10^(9)/L;凝血功能:凝血酶原时间(prothrombin time, PT)18.9 s,纤维蛋白原浓度(fibrinogen, FiB)1.31 g/L,D二聚体(D dimer, DD)>6μg/mL,纤维蛋白/原降解产物(fibrinogen degrdtion products, FDP)25.86μg/mL;超声检查和影像学表现提示肝挫裂伤/肝内血肿、脾挫裂伤、腹腔大量积血;判断患者出血量≥2 000 mL,术中需大量输血;术中及时输注红细胞成分,并根据患者血常规及凝血功能检测结果指导血液成分输注,为患者的成功救治提供了有力支撑和保障。患者术后恢复良好,常规检测结果:RBC计数4.32×10^(12)/L,Hb 144 g/L,HCT 39.50%,PLT计数329.00×10^(9)/L;凝血功能:活化部分凝血酶时间(activatedpartialthromboplastintime, APTT) 29.3 s, PT 12.1 s, FiB 2.728 g/L,DD>6μg/mL,FDP 25.86μg/mL。20 d后出院,出院后定期复查,复查结果无异常。结论 个体化PBM应全面考虑患者的临床症状、血红蛋白下降程度和动态凝血检测结果以及现有救治条件综合制定,高效合理的患者PBM可有效改善高原高寒地区大量输血患者的临床结局。Objective To explore the strategy of blood management in patients with massive transfusion in the frigid plateau region.Methods The treatment process of a patient with liver rupture in the frigid plateau region was analyzed,and the blood management strategy of the frigid plateau region was discussed in combination with the difficulties of blood transfusion and literature review.Results The preoperative complete blood count(CBC)test results of the patient were as follows:RBC 3.14×10^(12)/L,Hb 10^(6) g/L,HCT 30.40%,PLT 115.00×10^(9)/L;coagulation function:PT 18.9 s,FiB 1.31 g/L,DD>6μg/mL,FDP 25.86μg/mL;ultrasound examination and imaging manifestations suggested liver contusion and laceration/intraparenchymal hematoma,splenic contusion and laceration,and massive blood accumulation in the abdominal cavity;it was estimated that the patient′s blood loss was≥2000 mL,and massive blood transfusion was required during the operation;red blood cell components were timely transfused during the operation,and the blood component transfusion was guided according to the patient′s CBC and coagulation function test results,providing strong support and guarantee for the successful treatment of the patient.The patient recovered well after the operation,and the CBC test results were as follows:RBC 4.32×10^(12)/L,Hb 144 g/L,HCT 39.50%,PLT 329.00×10^(9)/L;coagulation function:APTT 29.3 s,PT 12.1 s,FiB 2.728 g/L,DD>6μg/mL,FDP 25.86μg/mL.The patient was discharged after 20 days,and regular follow-up reexamination showed no abnormal results.Conclusion Individualized blood management strategy should comprehensively consider the patient’s clinical symptoms,the degree of hemoglobin decline,dynamic coagulation test results and existing treatment conditions.Efficient and reasonable patient blood management strategies can effectively improve the clinical outcomes of massive transfusion patients in the frigid plateau region.

关 键 词：高原高寒地区 大量输血 患者血液管理 

分 类 号：R457.1[医药卫生—治疗学]