红细胞悬液与血浆不同比例输注对急性创伤患者凝血功能、纤溶功能及血栓弹力图监测结果的影响

目的探讨大量输血时,红细胞悬液与血浆不同比例输注对急性创伤患者凝血功能、纤溶功能及血栓弹力图(TEG)监测结果的影响。方法荣县人民医院收治的120例需要大量输血的患者,按入院24 h内输注新鲜冰冻血浆(FFP)与红细胞悬液(SRBC)的比例,以100 ml∶1U为比例单位,将患者分为低比例组(FFP∶SRBC=1∶3,n=32)、中比例组(FFP∶SRBC=1∶2,n=43)和高比例组(FFP∶SRBC=1∶1,n=45);比较三组一般资料、凝血功能、纤溶功能及血栓弹力图(TEG)监测结果。结果输血1 d后,中比例组和高比例组患者的凝血酶原时间(PT)、激活的部分凝血活酶时间(APTT)低于低比例组,蛋白C(PC)、纤维蛋白原(FIB)、凝血反应时间(R)、切线与水平夹角(α-Angle)及最大振幅(MA)均高于低比例组(P<0.05);高比例组D-D显著高于低比例组,FIB和MA高于中比例组(P<0.05)。结论输注时提高血浆浓度可有效改善急性创伤患者的凝血功能及纤溶功能,同时改善TEG的监测结果。

The effects of different ratios of suspended red blood cell to plasma for infusion on coagulation function,fibrinolytic function and monitoring results of thromboelastogram in patients with acute trauma

Objective Objective To explore the effect of different ratios of suspended red blood cell(SRBC)to plasma for infusion on coagulation function,fibrinolytic function and monitoring results of thromboelastogram(TEG)in patients with acute trauma.Methods A retrospective analysis was performed on the clinical data of 120 patients who needed massive blood transfusion in our hospitals.According to different ratios of fresh frozen plasma(FFP)to SRBC within 24 h after admission(taking 100 ml∶1U as the ratio unit),they were divided into low ratio group(FFP∶SRBC=1∶3,n=32),medium ratio group(FFP∶SRBC=1∶2,n=43)and high ratio group(FFP∶SRBC=1∶1,n=45).The general data,coagulation function,fibrinolytic function and TEG monitoring results were compared among the three groups.Results After 1 day of blood transfusion,prothrombin time(PT),activated partial thromboplastin time(APTT)and protein C(PC)were significantly lower while fibrinogen(FIB),reaction time(R),α-Angle and maximum amplitude(MA)were significantly higher in the medium and high ratio groups than those in the low ratio group(P<0.05).D-dimer(D-D)in the high ratio group was significantly higher than that in the low ratio group and FIB and MA were significantly higher than those in the medium ratio group(P<0.05).Conclusion Increasing plasma concentration during infusion can effectively improve the coagulation function and fibrinolytic function of acute trauma patients,and improve the monitoring results of TEG.