摘要
目的评价不同浓缩红细胞（PRBC）：新鲜冰冻血浆（FFP）比例对创伤大输血患者预后的影响。方法采用回顾性队列研究分析2007年1月-2015年6月收治的210例初始24h输PRBC≥10U的成人创伤大输血患者，并按24h内PRBC：FFP比例分为四组：A组（PRBC：FFP≤1，41例）、B组（1〈PRBC：FFP≤1．5，63例）、C组（1．5〈PRBC：FFP≤2，30例）和D组（PRBC：FFP〉2，76例）。观察并比较各组24h内输血量及其比例、不良反应（主要包括过敏反应、非溶血性发热反应、溶血反应、充血性心功能衰竭和肺水肿等）、入院24h后凝血功能变化[包括血红蛋白（Hb）、血小板计数（PC）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、国际标准化比值（INR）]及预后变化[包括序惯性脏器功能衰竭评分（SOFA）、总住院时间、ICU住院时间、30d病死率及死亡原因等]。结果A组PRBC输注量显著低于其他三组（P〈0．01）；输血后不良反应在各组间差异无统计学意义（P〉0．05）。A、B两组输血后的凝血指标（PT、APTT、INR）较D组显著降低（P〈0．05）。各组总住院时间和ICU住院时间差异无统计学意义（P〉0．05）。D组SOFA评分和30d病死率显著高于其他三组（P〈0．01），A、B、C三组间差异无统计学意义（P〉0．05），同时D组死于大出血的比例也显著高于其他三组（P〈0．01）。D组的生存时间最短，B、C组最长。结论伤后24h内保持适当的输血比例（1．5〈PRBC：FFP≤2）可改善创伤大输血患者的预后。进一步提高比例虽然可以改善凝血指标，甚至减少PRBC用量，但不改善预后。
Objective To evaluate the prognostic effect of different ratios of fresh frozen plasma （FFP） to packed red blood cells （PRBC） in massively transfused trauma patients. Methods A retrospective cohort study was conducted for 210 trauma patients who received more than 10 units of PRBC during the initial 24 hours from January 2007 to June 2015. The patients were divided into four groups： Group A（ PRBC ： FFP ≤1, n=41）, GroupB （1 〈PRBC： FFP≤1.5, n=63）, GroupC（1.5〈PRBC ： FFP≤2, n=30） and Group D （ PRBC ： FFP 〉 2, n = 76）. At 24 hours after admission, blood transfusion amount, blood transfusion ratios, post-transfusion adverse reactions （allergy, non-hemolytic febrile transfusion reaction, hemolysis, congestive heart failure, pulmonary edema, etc） and coagulation changes [hemoglobin （Hb）, platelet count （ PC）, prothrombin time（ PT）, activated partial thromboplastin time（ APTT）, international normalized ratio （INR）, etc ] were compared among groups. Prognostic markers including sequential organ failure assessment（ SOFA）, hospital stay, ICU stay, 30-day mortality and causes of death were also evaluated. Results Use of PRBC was decreased significantly in Group A than in other groups （P 〈 0.01 ）, and there were no differences in blood transfusion adverse reactions among all groups （P 〉 0.05 ）. The coagulation indices （PT, AFFF and INR） in Groups A and B were significantly decreased compared to Group D after transfusion （ P 〈 0.05 ）. There were no differences in length of hospital stay and ICU stay among all groups （P 〉 0.05 ）. Group D was associated with higher SOFA and higher 30-day mortality than other groups（ P 〈0.01 ）, but no differences were found in Group A, B and C （P 〉0.05 ）. Meanwhile, ratio of patients died of massive hemorrhage in Group D was also higher than other groups （P 〈0.01 ）. Kaplan-Meier survival analysis showed the survival interval was the shortest in Group D, while the longest in Group B and C. Condusions Modest transfusion ratios（ 1. 5 〈 PRBC ： FFP 42 ） within 24 hours can substantially improve outcomes in trauma patients. Aggressive ratios may improve coagulation indices and reduce use of PRBC, with no more benefit to the outcomes.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第5期453-458,共6页
Chinese Journal of Trauma
基金
上海卫生计生系统重要薄弱学科建设计划（2016ZB0205）
关键词
血液成分输血
创伤和损伤
预后
Blood component transfusion
Wounds and injuries
Prognosis
