早期干预凝血策略在严重创伤大量输血患者中的应用价值
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摘要
目的探讨早期干预凝血策略在严重创伤大量输血患者中的应用价值。方法选取2017年3月～2018年3月在四川绵阳四○四医院(以下简称"我院")行早期干预凝血策略期间44例严重创伤需大量输血患者为研究组;选取2016年2月～2017年2月在我院行常规输血策略期间44例严重创伤需大量输血患者为对照组。比较两组急性呼吸窘迫综合征(ARDS)发生率、死亡率及血气分析、凝血功能。结果干预后,研究组ARDS发生率、死亡率均低于对照组(P <0.05);输血后1、5 d,研究组pH、动脉血氧分压(PaO_2)均高于对照组,二氧化碳分压(PaCO_2)低于对照组(P <0.05);输血后1 d,研究组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均低于对照组,纤维蛋白原(FIB)、血小板计数(PLT)高于对照组(P <0.05);输血后5 d,研究组PT、TT、FIB、PLT均高于对照组,APTT低于对照组(P <0.05)。结论严重创伤大量输血患者行早期干预凝血策略,可降低ARDS发生率及死亡率,改善血气分析,减轻对凝血功能的影响。
Objective To explore the application value of early intervention coagulation strategy in patients with massive transfusion after severe trauma. Methods From March 2017 to March 2018, 44 patients with severe trauma requiring massive blood transfusion during the period of early intervention coagulation strategy in Mianyang 404 Hospital of Sichuan( "our hospital" for short) were selected as the research group, 44 patients with severe trauma requiring massive blood transfusion during the period of routine blood transfusion in our hospital from February 2016 to February2017 were selected as the control group. The incidence, mortality, blood gas analysis and coagulation function of acute respiratory distress syndrome(ARDS) were compared between the two groups. Results After the intervention, the incidence and mortality of ARDS in the study group were lower than those in the control group(P < 0.05); 1 and 5 days after transfusion, pH and partial arterial oxygen pressure(PaO_2) in the study group were higher than those in the control group, and partial carbon dioxide pressure(PaCO_2) were lower than those in the control group(P < 0.05); 1 d after transfusion, Prothrombin time(PT), activation time of partial thrombin(APTT) and thrombin time(TT) were all lower in the study group than in the control group, while fibrinogen(FIB) and platelet count(PLT) were higher in the study group than in the control group(P < 0.05); 5 d after transfusion, PT, TT, FIB and PLT in the study group were all higher than those in the control group, and APTT was lower than that in the control group(P < 0.05). Conclusion Early intervention of coagulation strategy in patients with severe trauma and massive transfusion can reduce the incidence and mortality of ARDS, improve blood gas analysis, and reduce the impact on coagulation function.
Objective To explore the application value of early intervention coagulation strategy in patients with massive transfusion after severe trauma. Methods From March 2017 to March 2018, 44 patients with severe trauma requiring massive blood transfusion during the period of early intervention coagulation strategy in Mianyang 404 Hospital of Sichuan( "our hospital" for short) were selected as the research group, 44 patients with severe trauma requiring massive blood transfusion during the period of routine blood transfusion in our hospital from February 2016 to February2017 were selected as the control group. The incidence, mortality, blood gas analysis and coagulation function of acute respiratory distress syndrome(ARDS) were compared between the two groups. Results After the intervention, the incidence and mortality of ARDS in the study group were lower than those in the control group(P < 0.05); 1 and 5 days after transfusion, pH and partial arterial oxygen pressure(PaO_2) in the study group were higher than those in the control group, and partial carbon dioxide pressure(PaCO_2) were lower than those in the control group(P < 0.05); 1 d after transfusion, Prothrombin time(PT), activation time of partial thrombin(APTT) and thrombin time(TT) were all lower in the study group than in the control group, while fibrinogen(FIB) and platelet count(PLT) were higher in the study group than in the control group(P < 0.05); 5 d after transfusion, PT, TT, FIB and PLT in the study group were all higher than those in the control group, and APTT was lower than that in the control group(P < 0.05). Conclusion Early intervention of coagulation strategy in patients with severe trauma and massive transfusion can reduce the incidence and mortality of ARDS, improve blood gas analysis, and reduce the impact on coagulation function.
引文
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[20]李洁平,李俊娥,罗世伟.外伤患者大量输血后对电解质、凝血功能及免疫功能的影响研究[J].中国实验诊断学,2018,22(1):70-72.
[2]王瑞,陈奇.输血致血小板减少性紫癜1例[J].西南国防医药,2016,26(5):564-564.
[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.
[4]罗立峰,岑萌,翁建丰.重型颅脑损伤并发急性呼吸窘迫综合征危险因素分析[J].重庆医学,2017,36(A01):148-149.
[5]张献清.实用临床输血医学[M].西安:第四军医大学出版社,2014:68.
[6]Wurmb TE,Bernhard M.Total-body CT for initial diagnosis of severe trauma[J].Lancet,2016,388(10045):636-638.
[7]Chicofernández M,Llompartpou JA,Guerrerolópez F,et al Epidemiology of severe trauma in Spain.Registry of trauma in the ICU(RETRAUCI)Pilot phase[J].Med Intensiva,2016,40(6):327-347.
[8]罗红敏.严重创伤患者成分输血比例对患者预后的影响:一项多中心随机对照试验[J].中华危重病急救医学,2016,28(3):261.
[9]凌亚豪,魏金锋,王爱平,等.急性肺损伤和急性呼吸窘迫综合征发病机制的研究进展[J].癌变·畸变·突变,2017,29(2):151-154.
[10]葛庆岗,姚智渊,王铁华,等.急性呼吸窘迫综合征发生及预后危险因素的多中心前瞻性队列研究[J].中华危重病急救医学,2014,26(11):773-779.
[11]杨天星,曾亚丽,叶碧华,等.不同输血策略对严重创伤大量输血并发ARDS影响[J].中国医学创新,2017,14(12):40-43.
[12]乔显森,王同显.严重创伤患者大量输血的预测模型及其评价[J].中国输血杂志,2016,29(6):652-655.
[13]杨宝义,汪蓉,邓春艳,等.基于问题管理模式的ICU输血安全管理效果探讨[J].中国医药导报,2018,481(23):162-165.
[14]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.
[15]张颖,任惠彦,郑燕蓉.大量输血对受血者凝血功能的影响[J].武警医学,2016,27(4):353-355.
[16]袁玉荣,王鹏.创伤及大量输血后凝血病1例[J].临床血液学杂志(输血与检验),2016,29(2):341-342.
[17]贺波.严重创伤患者大失血所致凝血功能障碍与预后的关系[J].血栓与止血学,2016,22(4):422-423.
[18]李辉,陈少军,唐朝晖,等.多发伤患者低体温、酸中毒及凝血功能障碍临床研究[J].中华急诊医学杂志,2015,24(3):310-314.
[19]梁浩,易杰.低体温对患者围手术期出血及凝血功能的影响[J].国际麻醉学与复苏杂志,2016,37(11):1031-1035.
[20]李洁平,李俊娥,罗世伟.外伤患者大量输血后对电解质、凝血功能及免疫功能的影响研究[J].中国实验诊断学,2018,22(1):70-72.