产后出血患者大量输血治疗时血浆和红细胞的比例对凝血功能的影响

摘要

目的 探讨产后大出血患者早期大量输血时,输入新鲜冰冻血浆(FFP)和红细胞(RBC)的比例对凝血功能的影响.方法 因产后大出血24 h内需输注RBC大于10 U的患者45例,按输注FFP与悬浮RBC的比例,随机分为低血浆组(A组,FFP∶ RC=1∶2.5,15例)、中血浆组(B组,FFP∶ RBC=1∶1,16例)和高血浆组(C组,FFP∶ RBC=1.5∶1,14例).检测产前和输血后24h凝血功能和血常规,比较三组患者大量输血后24h内RBC和冷沉淀输入量的差异.结果 三组患者产前凝血功能、血常规比较无统计学差异(P＞0.05).大量输血24 h后,A组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)延长,纤维蛋白原(Fbg)含量降低(P＜0.05),B、C组凝血功能无明显变化(P＞0.05);三组患者大量输血后血小板计数(Plt)及血红蛋白(Hb)均降低(P＜0.05),B组优于A、C组(P＜0.05).三组间24 h内输注RBC和冷沉淀的量无统计学差异(P＞0.05).结论 产后大出血患者输血时,FFP与RBC比例过低,可造成血液稀释性低凝,建议以1∶1比例输注为宜.%Objective To investigate the effect of ratio of fresh frozen plasma(FFP) to red blood cells (RBC) on coagulation function in the patients with massive blood transfusion for postpartum hemorrhage.Methods Forty-five patients with blood transfusion more than 10 U in 24 hours were randomly assigned into three groups of A(ratio of FFP to RBC 1 ∶ 2.5,15 cases),B(ratio of FFP to RBC 1 ∶ 1,16 cases) and C(ratio of FFP to RBC 1.5 ∶ 1,14 cases).The coagulation function was examined before delivery and at 24 hours after transfusion.The volumes of RBC and cryoprecipitate infused in 24 hours were compared among three groups.Results The tests of coagulation function,platelet and hemoglobin (Hb) of three groups were similar before delivery (P＞0.05).The prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly prolonged and fibrinogen was decreased at 24 hours after transfusion(P＜0.05),which were not significantly changed in groups of B and C(P＞0.05).The platelet counts and Hb of three groups were lower after transfusion than those before(P＜0.05),which were better in group B than those in groups of A and C(P＜0.05).The volumes of RBC and cryoprecipitate infused in 24 hours in three groups were similar(P＞0.05).Conclusion In the patients with massive blood transfusion for postpartum hemorrhage,lower ratio of FFP to RBC easily produces a dilutive low coagulation status,for which a rational ratio of 1 ∶ 1(FFP to RBC) is suggested.