Study on blood index and coagulation status of patients with massive blood transfusion due to acute trauma
-
摘要:目的 探讨急症创伤大量输血患者的血液指标及凝血状态变化情况。方法 选取98例急症创伤需大量输血患者(均需输注大于8 U的红细胞)作为研究对象，将入院24 h内输注悬浮红细胞: 血浆比例为1∶ 1的患者设为A组，将比例为1.5∶ 1的患者设为B组，将比例为2∶ 1的患者设为C组。对所有患者输血前后凝血指标、血液指标等进行检测，比较3组患者血液指标和凝血指标的变化情况。结果 与输血前比较, 3组患者大量输血后的凝血活酶时间(APTT)、凝血酶原时间(PT)延长，纤维蛋白原(FIB)水平降低，差异均有统计学意义(P < 0.05); 输血后, A组、B组的APTT、PT、FIB水平比较，差异无统计学意义(P>0.05), C组的APTT、PT水平高于A组、B组, FIB水平低于A组、B组，差异有统计学意义(P < 0.05)。与输血前比较, 3组患者大量输血后的血小板计数(PLT)水平降低，血红蛋白(Hb)、红细胞压积(HCT)水平升高，差异均有统计学意义(P < 0.05); 输血后, A组、B组的PLT、Hb、HCT水平比较，差异无统计学意义(P>0.05), C组的PLT水平低于A组，差异有统计学意义(P < 0.05)。结论 大量悬浮红细胞的输注会明显造成患者凝血功能障碍，建议输血时悬浮红细胞：血浆为1∶ 1或1.5∶ 1, 且在输血前后密切监测患者的血液指标及凝血状态，及时补充血小板等成分，以提升救治成功率。Abstract:Objective To study the changes of blood index and coagulation status in patients with massive blood transfusion due to acute trauma.Methods A total of 98 patients(all requiring more than 8 U red cells) with acute trauma treated in our hospital were enrolled in this study. The patients with a ratio of 1 to 1 at 24 h of admission(suspended erythrocyte to plasma) were included in the group A, and those with a ratio of 1.5 to 1 were as group B, and the those with a ratio of 2 to 1 were in the group C. Blood coagulation function and blood index were measured before and after blood transfusion in all patients, and the changes of above indicators of the two groups were observed and compared.Results Compared with transfusion before, the activated partial thromboplastin time(APTT) and prothrombin time (PT) of three groups after massive transfusion were prolonged, the FIB level was decreased, and the differences were statistically significant (P < 0.05); the APTT, PT and fibrinogen (FIB) levels of group A and group B showed no significant differences (P>0.05), but the APTT and PT levels of group C were higher and the FIB level was lower than group A and group B (P < 0.05). Compared with before transfusion, blood platelet count (PLT) of the three groups was reduced, hemoglobin (Hb) and hematocrit (HCT) were significantly increased (P < 0.05). There were no significant differences in PLT, Hb, HCT levels between group A and group B(P>0.05). PLT level in group C was significant lower than group A (P < 0.05).Conclusion Massive transfusion of suspended red blood cells can cause disorder of coagulation function, so it is suggested to maintain ratio of 1 to 1 or 1.5 to 1(suspended erythrocyte to plasma), and strengthen the detection of coagulation function and timely supplement missed platelets in the treatment of patients with massive trauma to improve the success rate of treatment.
-
Keywords:
- acute trauma /
- massive blood transfusion /
- blood index /
- coagulation status /
- platelets
-
-
表 1 3组患者输血前后凝血功能指标变化情况比较(x±s)
组别 时点 APTT/s PT/s FIB/(g/L) A组(n=31) 输血前 35.41±7.02 13.13±2.70 3.11±0.42 输血后 45.73±7.20*# 25.34±3.42*# 2.82±0.53*# B组(n=40) 输血前 38.74±6.43 13.77±2.43 2.87±0.62 输血后 47.05±6.72*# 23.64±4.55*# 2.75±0.37*# C组(n=27) 输血前 32.14±6.27 12.97±2.13 3.37±0.70 输血后 52.23±8.05* 32.31±2.80* 2.43±0.52* APTT: 凝血活酶时间; PT: 凝血酶原时间; FIB: 纤维蛋白原。与输血前比较, *P＜0.05; 与C组比较, #P＜0.05。 
下载: 导出CSV
表 2 3组患者输血前后血液指标变化情况比较(x±s)
组别 时点 PLT/(×109/L) Hb/(g/L) HCT/% A组(n=31) 输血前 129.55±31.64 82.85±17.24 0.26±0.05 输血后 107.48±29.11* 87.13±12.82* 0.29±0.09* B组(n=40) 输血前 118.48±36.14 78.85±18.37 0.23±0.08 输血后 97.58±31.04* 82.15±14.22* 0.26±0.14* C组(n=27) 输血前 123.78±29.05 80.08±16.14 0.25±0.06 输血后 85.36±32.38*# 83.46±13.50* 0.27±0.12* PLT: 血小板计数; Hb: 血红蛋白; HCT: 红细胞压积。与输血前比较, *P＜0.05; 与A组比较, #P＜0.05。
下载: 导出CSV
-
[1] 张斌. 凝血四项及血小板计数动态监测在严重创伤患者大量输血中的应用价值[J]. 河南医学研究, 2018, 27(23): 4302-4303. doi: 10.3969/j.issn.1004-437X.2018.23.037 [2] 隆维东, 谭兵, 肖剑平. 大量输血对外伤性患者纤维蛋白原和血小板及血清炎症反应影响研究[J]. 山西医药杂志, 2016, 45(15): 1824-1826. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY201615040.htm [3] 刘业, 唐晓峰, 周晔, 等. 大量输血对急性创伤患者凝血功能和纤溶系统的影响[J]. 海南医学院学报, 2017, 23(6): 755-758. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201706011.htm [4] 曹阳. 老年严重创伤患者大量输血时凝血指标动态监测的价值分析[J]. 国际检验医学杂志, 2018, 39(17): 2095-2097, 2101. doi: 10.3969/j.issn.1673-4130.2018.17.005 [5] 江光荣, 周炜, 罗立. 大量输血对严重创伤患者凝血功能的影响[J]. 实验与检验医学, 2017, 35(4): 629-630, 632. doi: 10.3969/j.issn.1674-1129.2017.04.064 [6] 吴玲, 谷世娟. 手术大量输血患者用血情况及血液检测指标变化分析[J]. 中国继续医学教育, 2018, 10(14): 98-99. doi: 10.3969/j.issn.1674-9308.2018.14.048 [7] 曾月婷, 梁结玲, 莫水群, 等. 大量输血后常见血液指标变化情况分析及影响因素研究[J]. 齐齐哈尔医学院学报, 2017, 38(20): 2383-2385. doi: 10.3969/j.issn.1002-1256.2017.20.011 [8] 马进礼. 急诊创伤治疗中不同输血量对患者凝血功能的影响[J]. 中国继续医学教育, 2017, 9(24): 146-147. doi: 10.3969/j.issn.1674-9308.2017.24.079 [9] 李兴华, 王恩波. 大量输血对患者血液指标影响的研究[J]. 检验医学与临床, 2017, 14(15): 2318-2320. doi: 10.3969/j.issn.1672-9455.2017.15.058 [10] 秦燕. 大量输血治疗后患者血液检验指标变化及影响因素分析[J]. 中西医结合心血管病电子杂志, 2017, 5(22): 86-86. doi: 10.3969/j.issn.2095-6681.2017.22.062 [11] 黄小燕, 唐周舟, 吴秋芳. 严重创伤患者大量输血时动态监测凝血指标的临床意义[J]. 现代医学, 2017, 45(1): 79-82. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201701021.htm [12] 张楠, 屈跃军, 白振宇. 创伤性失血患者大量输血前后凝血功能与血液指标变化分析[J]. 医药论坛杂志, 2016, 37(10): 55-57. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201610020.htm [13] 赵海涛, 胡旭梅, 王敬波, 等. 创伤患者大量输血后凝血指标变化情况分析[J]. 华西医学, 2015, 30(9): 1692-1694. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201509025.htm [14] 陈楚填, 李裕葵, 张少丰, 等. 严重创伤患者大量输血对凝血功能的影响[J]. 中国民族民间医药杂志, 2015, 24(11): 116-116. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL202013051.htm [15] 马增新, 倪广臻, 胡雪伟, 等. 外科患者大量输血后不同时间凝血功能指标变化的动态分析[J]. 中国伤残医学, 2014, 22(9): 29-31. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYZ201409021.htm -
期刊类型引用(4)
1. 黄静，麦才群，刘光萍. 聚焦解决护理模式对胎膜早破产妇分娩方式及母婴结局的影响. 保健医学研究与实践. 2022(11): 136-138+150 . 
百度学术
2. 何红. 强化产科护理干预对胎膜早破期待治疗病人分娩方式及母婴并发症的影响. 全科护理. 2020(13): 1613-1615 . 百度学术
3. 赵建英. 多重护理在胎膜早破产妇感染预防中的应用效果. 中国当代医药. 2019(26): 223-225 . 百度学术
4. 黄宝珍. 足月胎膜早破产妇综合护理干预的效果研究. 护理实践与研究. 2018(19): 96-97 . 百度学术
其他类型引用(0)
表(2)
计量
- 文章访问数: 229
- HTML全文浏览量: 122
- PDF下载量: 5
- 被引次数: 4
苏公网安备 32100302010246号
