新鲜冰冻血浆与红细胞悬液不同比例输注对消化道出血患者凝血功能的影响

陈瑜　魏建

[摘要] 目的 探討消化道大出血患者输注不同比例新鲜冰冻血浆与红细胞悬液对患者凝血功能的影响。 方法 选取消化道大出血患者50例，依据新鲜冰冻血浆与红细胞悬液输注比例分为低比例血浆组17例、中比例血浆组21例、高比例血浆组12例。监测输血前后患者凝血功能指标变化情况。 结果 三组不同比例血浆-红细胞悬液输注组患者输血前凝血功能指标比较，差异无统计学意义。而大量输注血浆和红细胞悬液后，低比例血浆组患者APTT、PT均显著延长，Fbg水平降低，差异均有统计学意义（P<0.05）；高比例血浆组APTT和PT也有所延长，但延长时间短于低比例血浆组，Fbg浓度也有所降低，同样减少幅度低于低比例血浆组患者，差异均有统计学意义（P<0.05）；而中比例血浆组患者其APTT、PT和Fbg与输血前相比无明显变化，差异无统计学意义（P>0.05）。 结论 消化道大出血患者在临床输血时，应避免血浆和红细胞悬液比例失调，低比例血浆可诱发血液低凝现象产生，以血浆∶红细胞悬液为1∶1较好。

[关键词] 消化道大出血；血浆；红细胞悬液；凝血功能；低比例

[中图分类号] R573.2 [文献标识码] B [文章编号] 1673-9701（2017）36-0084-03

[Abstract] Objective To investigate the effect of different proportions of fresh frozen plasma and red blood suspension infusion on blood coagulation in the patients with gastrointestinal hemorrhage. Methods 50 patients with gastrointestinal bleeding were selected. According to the proportions of fresh frozen plasma and red blood suspension infusion， the patients were assigned to 17 patients in low proportion plasma group， 21 patients in middle proportion plasma group and 12 patients in high proportion plasma group. The changes in coagulation function indices before and after transfusion were monitored. Results There was no statistically significant difference in blood coagulation indices before transfusion in three infusion groups of patients with different proportions of plasma-red blood suspension. After massive infusion of plasma and red blood suspensions， APTT and PT were significantly prolonged in the low proportion plasma group， Fbg level was decreased， and the differences were statistically significant（P<0.05）； APTT and PT were also prolonged in high proportion plasma group， but the prolonging time was shorter than that in the low proportion plasma group， and the Fbg concentration was also decreased. The same reduction degree was lower than that in low proportion plasma group， and the difference was statistically significant（P<0.05）； however， APTT， PT and Fbg in the middle proportion plasma group were not significantly different compared with those before transfusion， and the differences were not statistically significant（P>0.05）. Conclusion Patients with gastrointestinal bleeding in clinical transfusion should avoid the imbalance of the proportion of plasma and red blood suspension. Low proportion plasma can induce the phenomenon of low blood coagulation， so the ratio of plasma ： red blood cell suspension should be 1： 1 for the best effect.

[Key words] Gastrointestinal hemorrhage； Plasma； Red blood suspension； Blood coagulation； Low proportion

消化道大出血患者由于起病急、失血快且失血量大，需大量输血快速扩充血容量，以维持血压[1]。但短时间大量输注成分血往往会导致患者凝血功能障碍，诱发患者死亡[2]。因此，及时有效地监测大量输血患者凝血功能显得至关重要，而探讨血浆和红细胞悬液适当比例输注尤为关键。据此，本研究通过检测不同比例血浆与红细胞悬液对消化道大出血患者凝血功能的影响，得出其输血时最佳输注比例。

1 资料与方法

1.1 一般资料

选取我院2015年4月～2016年8月收治的消化道大出血患者50例，输血量均在1000 mL以上，其中男28例，女22例，年龄26～62岁，平均（45.37±15.48）岁。……