中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2015年
6期
553-556
,共4页
孙玲玲%方卫平%汪萍%汪卫星
孫玲玲%方衛平%汪萍%汪衛星
손령령%방위평%왕평%왕위성
血液成分输血%输注,静脉内%预后
血液成分輸血%輸註,靜脈內%預後
혈액성분수혈%수주,정맥내%예후
Blood component transfusion%Infusions,intravenous%Prognosis
目的 回顾性分析围术期输注不同比例血浆和红细胞(RBC)对大量输血患者预后的影响.方法 选择2010年1月一2012年9月24 h内输注RBC≥10U手术患者139例,根据围术期输注新鲜冰冻血浆(FFP)与RBC的比例,将患者分为三组:高比例组(FFP∶ RBC＞1∶1)19例、中比例组(FFP∶ RBC=1∶2 ～1∶1)43例、低比例组(FFP∶ RBC＜1∶2)77例.比较三组住院期间血制品输注情况以及大量输血前后血常规指标、凝血功能指标、电解质指标、住院时间、住ICU时间、治愈率及病死率的差异. 结果 (1)FFP输注量高比例组最多为(2 600±1 582) ml,中比例组较多为(1 390±1 043) ml,低比例组最少为(318 ±342) ml(P ＜0.05);血小板(PLT)输注量高比例组(0～1.4 U)和中比例组(0～1.0 U)均较低比例组多(0～0.0 U)(P＜0.05);三组在RBC和冷沉淀输注量上差异均无统计学意义.(2)输血前,中比例组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)[(20.2±10.7)s、(57.2±45.8)s]较高比例组和低比例组均明显延长[(14.3±4.4)s、(35.3 ± 10.0)s和(12.5±1.7)s、(31.5±5.9)s](P＜0.05),三组血红蛋白(Hb)、PLT、国际标准化比值(INR)、K+及Ca2浓度差异均无统计学意义;输血后,低比例组Hb为(106.8 ±31.7)g/L,较中比例组和高比例组高[(82.5±32.2) g/L、(91.3±19.1)g/L] (P ＜0.05),低比例组Ca2浓度为(1.99±0.24) mmol/L,较中比例组和高比例组高[(1.76±0.38) mmol/L、(1.96±0.25) mmol/L](P＜0.05),三组PLT、PT、INR、APTT及K+浓度差异均无统计学意义.(3)三组住院时间、住ICU时间、治愈率及病死率差异均无统计学意义. 结论 对于大量输血患者,按FFP∶RBC =1∶2～1∶1输注,将有利于预防大量输血患者发生凝血功能障碍,减少患者住院期间血浆输注总量,对预后无影响.
目的 迴顧性分析圍術期輸註不同比例血漿和紅細胞(RBC)對大量輸血患者預後的影響.方法 選擇2010年1月一2012年9月24 h內輸註RBC≥10U手術患者139例,根據圍術期輸註新鮮冰凍血漿(FFP)與RBC的比例,將患者分為三組:高比例組(FFP∶ RBC＞1∶1)19例、中比例組(FFP∶ RBC=1∶2 ～1∶1)43例、低比例組(FFP∶ RBC＜1∶2)77例.比較三組住院期間血製品輸註情況以及大量輸血前後血常規指標、凝血功能指標、電解質指標、住院時間、住ICU時間、治愈率及病死率的差異. 結果 (1)FFP輸註量高比例組最多為(2 600±1 582) ml,中比例組較多為(1 390±1 043) ml,低比例組最少為(318 ±342) ml(P ＜0.05);血小闆(PLT)輸註量高比例組(0～1.4 U)和中比例組(0～1.0 U)均較低比例組多(0～0.0 U)(P＜0.05);三組在RBC和冷沉澱輸註量上差異均無統計學意義.(2)輸血前,中比例組凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)[(20.2±10.7)s、(57.2±45.8)s]較高比例組和低比例組均明顯延長[(14.3±4.4)s、(35.3 ± 10.0)s和(12.5±1.7)s、(31.5±5.9)s](P＜0.05),三組血紅蛋白(Hb)、PLT、國際標準化比值(INR)、K+及Ca2濃度差異均無統計學意義;輸血後,低比例組Hb為(106.8 ±31.7)g/L,較中比例組和高比例組高[(82.5±32.2) g/L、(91.3±19.1)g/L] (P ＜0.05),低比例組Ca2濃度為(1.99±0.24) mmol/L,較中比例組和高比例組高[(1.76±0.38) mmol/L、(1.96±0.25) mmol/L](P＜0.05),三組PLT、PT、INR、APTT及K+濃度差異均無統計學意義.(3)三組住院時間、住ICU時間、治愈率及病死率差異均無統計學意義. 結論 對于大量輸血患者,按FFP∶RBC =1∶2～1∶1輸註,將有利于預防大量輸血患者髮生凝血功能障礙,減少患者住院期間血漿輸註總量,對預後無影響.
목적 회고성분석위술기수주불동비례혈장화홍세포(RBC)대대량수혈환자예후적영향.방법 선택2010년1월일2012년9월24 h내수주RBC≥10U수술환자139례,근거위술기수주신선빙동혈장(FFP)여RBC적비례,장환자분위삼조:고비례조(FFP∶ RBC＞1∶1)19례、중비례조(FFP∶ RBC=1∶2 ～1∶1)43례、저비례조(FFP∶ RBC＜1∶2)77례.비교삼조주원기간혈제품수주정황이급대량수혈전후혈상규지표、응혈공능지표、전해질지표、주원시간、주ICU시간、치유솔급병사솔적차이. 결과 (1)FFP수주량고비례조최다위(2 600±1 582) ml,중비례조교다위(1 390±1 043) ml,저비례조최소위(318 ±342) ml(P ＜0.05);혈소판(PLT)수주량고비례조(0～1.4 U)화중비례조(0～1.0 U)균교저비례조다(0～0.0 U)(P＜0.05);삼조재RBC화랭침정수주량상차이균무통계학의의.(2)수혈전,중비례조응혈매원시간(PT)、활화부분응혈활매시간(APTT)[(20.2±10.7)s、(57.2±45.8)s]교고비례조화저비례조균명현연장[(14.3±4.4)s、(35.3 ± 10.0)s화(12.5±1.7)s、(31.5±5.9)s](P＜0.05),삼조혈홍단백(Hb)、PLT、국제표준화비치(INR)、K+급Ca2농도차이균무통계학의의;수혈후,저비례조Hb위(106.8 ±31.7)g/L,교중비례조화고비례조고[(82.5±32.2) g/L、(91.3±19.1)g/L] (P ＜0.05),저비례조Ca2농도위(1.99±0.24) mmol/L,교중비례조화고비례조고[(1.76±0.38) mmol/L、(1.96±0.25) mmol/L](P＜0.05),삼조PLT、PT、INR、APTT급K+농도차이균무통계학의의.(3)삼조주원시간、주ICU시간、치유솔급병사솔차이균무통계학의의. 결론 대우대량수혈환자,안FFP∶RBC =1∶2～1∶1수주,장유리우예방대량수혈환자발생응혈공능장애,감소환자주원기간혈장수주총량,대예후무영향.
Objective To retrospectively analyze the influence of perioperatively transfusing different ratios of fresh frozen plasma (FFP) to red blood cell (RBC) on prognosis of patients receiving massive transfusion.Methods From January 2010 to September 2012,139 surgical patients with transfusion of ≥ 10 RBC units within 24 hours were included in the study.Patients were categorised into three groups based on the FFP ∶ RBC scale:high scale group (FFP ∶ RBC ＞ 1 ∶ 1,n =19),middle scale group (FFP ∶ RBC =1 ∶ 2-1 ∶ 1,n =43) and low scale group (FFP ∶ RBC ＜ 1 ∶ 2,n =77).Comparison among the groups was made in aspects of transfusion of different blood products in hospital,blood routine index before and after massive transfusion,blood coagulation index,electrolyte index,hospital stay,ICU stay,cure rate and mortality.Results FFP transfusion was the most in high scale group (2 600 ± 1 582) ml,followed by (1 390 ± 1 043) ml in middle scale group and (318 ± 342) ml in low scale group (P ＜0.05).Platelet (PLT) transfusion was more in high scale group (0-1.4 units) and middle scale group (0-1.0 units) compared with that in low scale group (0-0.0 units,P ＜ 0.05).Volume of RBC and cryoprecipitate transfused revealed no significant differences among the groups (P ＞ 0.05).Before blood transfusion prothrombin time (PT) [(20.2 ± 10.7) s] and activated partial thromboplastin time (APTT) [(57.2±45.8) s] in middle scale group were significantly prolonged than those in high scale group [(14.3 ±4.4) s and (35.3 ± 10.0) s] and low scale group[(12.5 ± 1.7) s and (31.5 ± 5.9) s] (P ＜ 0.05),but the differences were insignificant in indices of hemoglobin (Hb),PLT,international normalized ratio (INR),K +,and Ca2 + (P ＞ 0.05).After blood transfusion Hb [(106.8 ± 31.7) g/L] and Ca2+[(1.99 ± 0.24)mmol/L] in low scale group were higher than these in middle scale group [(82.5 ± 32.2) g/L and (1.76 ± 0.38) mmol/L] and in high scale group [(91.3 ± 19.1) g/L and (1.96 ±0.25) mmol/L] (P ＜0.05),but there were no significant differences in PLT,PT,INR,APTT and K+(P ＞ 0.05).Moreover,hospital stay,ICU stay,cure rate and mortality were not differed significantly among the groups (P ＞ 0.05).Conclusion For massive transfusion patients,transfusion of FFP and RBC at a 1 ∶ 2 to 1 ∶ 1 ratio is beneficial to preventing coagulation dysfunction and reducing plasma total infusion volume,and exerts no effect on the prognosis.
