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血液成分的输血比例对大量输血患者死亡率影响
目的 分析血液成分不同输血比例对大量输血患者死亡率的影响.方法 选取我院收治的75例大量输血患者,纳入时间为2015年6月~2017年6月.依据FFP:CRBC比例,以100ml:1U作为比例单位,将其分为3组:低比例(1:3)组、中比例(1:2)组、高比例组(1:1)各25例,评定治疗效果.结果 输血后,三组患者的呼吸、体温、血压指标差异不大(P>0.05).治疗后患者的PT和APTT指标提高、FIB指标降低;且高比例组改善明显、中比例组次之,差异显著(P<0.05).低、中、高比例三组患者死亡率为16.0%、12.0%、8.0%,对比差异不大(P>0.05).结论 大量输血患者适当提高血浆输注比例,能有效防止凝血功能障碍发生,降低患者死亡风险.
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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
目的 探讨创伤性失血患者大量输注不同比例的悬浮红细胞和冰冻血浆后血液指标的变化,及时为临床治疗提供依据.方法 选择平顶山市平煤神马医疗集团总医院2013年1月-2015年6月,因创伤性出血导致的需输注悬浮红细胞大于10 U的患者89例,入院24h内输注悬浮红细胞:血浆(1∶1)的设为A组,悬浮红细胞:血浆(1.5∶1)设为B组,悬浮红细胞∶血浆(2∶1)设为C组,测定每组患者输血前后凝血功能和血小板计数(Plt)、血红蛋白(Hb)及红细胞压积(Hct)的变化.结果 观察3组患者大量输血后PT、APTT、时间较大量输血前明显延长,FIB值明显降低,患者大量输血前后检测数据比较,差异具有统计学意义(P＜0.05);不同输注比例患者HGB和Hct较大量输血前明显改善,但所有患者的PLT呈现下降趋势输血前后检测数据比较,差异具有统计学意义(P＜0.05).输血后A、B组凝血功能和血常规均显著优于C组.结论 创伤性失血患者大量输血虽是救治创伤患者的重要手段,但同时可能会使患者凝血功能发生紊乱.因此需严密监测凝血功能及血液指标的变化情况,以便及时补充冷沉淀、血小板血液成分,降低或避免因血小板和凝血功能异常引起的出血风险提高输血疗效,对指导临床输血有积极意义.
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血液成分的输血比例对大量输血患者死亡率影响
Massive transfusion is defined as the equal volume of transfusion to that of the loss of one within a 24 hours period or defined as receiving 10 or more units of red blood cells in 24 hours.However,this definition was full of controversy because of failing to eliminate survival bias.Other definitions have been put forward to improve it such as transfusion of the volume of 5 or more units of red blood cells in 4 hours or the rate of transfusion of 4 or more units of red blood cells per hour.Alternatively CAT,which was defined by receiving 3 or more units of red blood cells within any 1-hour time frame during the first 24 hours after injury,was raised to eliminate survival bias to some extent.Researchers have proposed the concept of Resuscitation Intensity,which was consisted of all fluids used for the initial resuscitation of a patient,not only red blood cells,plasma and platelets but also crystalloid,colloid,by carrying out the study of PROMMTT.As a result,the concept of Resuscitation Intensity is objective relatively to assess the severity of patients with massive loss of blood.The ratios of transfusion were concluded as 1∶1 for plasma relative to red blood cells as well as 1∶1∶1 for plasma,platelets relative to red blood cells home mostly.And for abroad it was still inconclusive of how patients benefiting from high ratios of transfusion of plasma relative to red blood cells or high ratios of transfusion of plasma,platelets relative to red blood cells.Therefore further researches ought to be carried out to clarify the relationship between the ratios of transfusion and its influence in the mortality of patients with massive transfusion.
