摘要
目的探讨不同的冰冻血浆(FP)与红细胞(RBC)配比对严重多发伤后失血性休克(HS)患者凝血功能和预后的影响。方法选择该院2020年1月至2023年1月收治的严重多发伤后HS患者150例,随机分为A组、B组和C组,每组50例。A组给予FP∶RBC为1∶1的输血方案进行治疗,B组给予FP∶RBC为1∶2的输血方案进行治疗,C组给予FP∶RBC为1∶2.5的输血方案进行治疗。比较3组患者血液制品使用情况,输血前后凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆凝血酶时间(TT)和纤维蛋白原(FIB)]、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)T细胞)水平,以及两组预后情况。结果3组患者RBC和血小板使用量比较,差异均无统计学意义(P>0.05);A组患者FP使用量高于B、C组,B组FP使用量高于C组,差异均有统计学意义(P<0.05)。3组患者输血前PT、APTT、TT及FIB水平比较,差异均无统计学意义(P>0.05);3组患者输血后PT、APTT、TT均低于输血前,而FIB水平高于输血前,差异均有统计学意义(P<0.05);输血后,A组患者PT、APTT、TT均低于B、C组,而FIB水平高于B、C组,差异均有统计学意义(P<0.05);输血后,B组患者PT、APTT、TT均低于C组,而FIB水平高于C组,差异均有统计学意义(P<0.05)。3组患者输血前CD3^(+)、CD4^(+)、CD8^(+)T细胞百分比比较,差异均无统计学意义(P>0.05);输血后,A组患者CD3^(+)、CD4^(+)T细胞百分比均高于B、C组,而CD8^(+)T细胞百分比低于B、C组,差异均有统计学意义(P<0.05);输血后,B组患者CD3^(+)、CD4^(+)T细胞百分比高于C组,而CD8^(+)T细胞百分比低于C组,差异均有统计学意义(P<0.05)。3组病死率比较,差异无统计学意义(P>0.05)。A组存活患者并发症发生率低于B、C组,而B组存活患者并发症发生率低于C组,差异均有统计学意义(P<0.05)。结论严重多发伤后HS患者采用FP∶RBC配比为1∶1的输血方案最佳,不仅对患者免疫功能影响较小、有效改善患者凝血功能,还可以有效降低患者并发症发生率。
Objective To explore the influence of different ratios of frozen plasma(FP)to red blood cell(RBC)on coagulation function and prognosis in patients with severe multiple trauma hemorrhagic shock(HS).Methods A total of 150 HS patients with severe multiple injury in the hospital from January 2020 to January 2023 were randomly divided into group A,group B and group C,50 cases in each group.The group A was given FP∶RBC with a 1∶1 regimen transfusion,the group B was given FP∶RBC with a 1∶2 regimen transfusion,and the group C was given FP∶RBC with a 1∶2.5 regimen transfusion.Compare the usage of blood products,coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),prothrombin time(TT),fibrinogen(FIB)],immune function indicators(CD3^(+),CD4^(+),CD8^(+)T lymphocytes)levels and prognosis of three groups before and after blood transfusion.Results There were no statistically significant differences in the usage of RBC and platelets among the three groups(P>0.05);the usage of FP in the group A was higher than that in the group B and group C,and the usage of FP in the group B was higher than that in the group C,with statistically significant differences(P<0.05).There were no statistically significant differences in PT,APTT,TT,FIB levels among the three groups before blood transfusion(P>0.05);the PT,APTT and TT of the three groups of after blood transfusion were lower than those before blood transfusion,and the FIB level was higher than that before blood transfusion,the differences had statistical significance(P<0.05);after blood transfusion,the PT,APTT and TT in group A were lower than those in the group B and group C,FIB level was higher than that in the group B and group C,with statistically significant differences(P<0.05);after blood transfusion,PT,APTT,and TT in the group B were lower than those in the group C,while FIB level was higher than that in the group C,with statistically significant difference(P<0.05).There was no statistically significant differences in percentages of CD3^(+),CD4^(+)and CD8^(+)among the three groups before blood transfusion(P>0.05);after blood transfusion,CD3^(+)and CD4^(+)in the group A were higher than those in the group B and group C,while the percentage of CD8^(+)was lower than that in the group B and group C,and the differences were statistically significant(P<0.05);after blood transfusion,the percentages of CD3^(+)and CD4^(+)s in the group B were higher than those in the group C,while the percentage of CD8^(+)was lower than that in the group C,with statistically significant differences(P<0.05).The mortality rates had no statistically significant difference among the three groups(P>0.05).The incidence of complications in survival patients in the group A was lower than that in the groups B and group C,while the incidence of complications in survival patients in the group B was lower than that in the group C,and the differences were statistically significant(P<0.05).Conclusion The application of FP∶RBC ratio 1∶1 blood transfusion therapy in severe multiple injury patients with HS not only has a small impact on the patient's immune function and effectively improves the patient's coagulation function,but also can effectively reduce the occurrence of complications in the patient.
作者
张芍药
王艳琴
周林苹
ZHANG Shaoyao;WANG Yanqin;ZHOU Linping(Department of Blood Transfusion,Jiangxi Province Integrated Traditional Chinese and Western Medicine Hospital,Nanchang,Jiangxi 330000,China)
出处
《检验医学与临床》
2024年第3期329-332,337,共5页
Laboratory Medicine and Clinic
关键词
血浆与红细胞配比
严重多发伤
失血性休克
凝血功能
免疫功能
ratio of plasma to red blood cells
severe multiple injuries
hemorrhagic shock
coagulation function
immunologic function
