紧急大量输血程序对创伤性休克患者影响的治疗体会

摘要

目的 探讨紧急大量输血程序(MTP)对创伤性休克患者生存预后的影响及其临床应用价值.方法 根据本院制定的紧急大量输血程序,对有完整大量输血记录的76例创伤性休克患者死亡率、死亡原因进行统计;动态监测大量输血程序前、MTP后1h、24h和7d的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血红蛋白(Hb)和血小板计数(PLT);统计MTP前后血液制品的使用情况.结果 死亡9例,死亡率11.8%,死亡原因主要为无法控制的出血;21例(27.6%)患者MTP前PT和APTT均大于正常的1.5倍,凝血功能指标PT和APTT以及血常规指标Hb和PLT的变化与MTP前和MTP后1h相比具有显著性差异(P<0.01);MTP后1h和24h相比无显著差异(P>0.05);MTP后7d和MTP后24h相比具有显著差异(P<0.01).MTP终止后,46例(86.7%)患者继续输注血制品,平均输注浓缩红细胞(PRBC)3.6U,新鲜冰冻血浆(FFP)5.5U.结论 紧急大量输血程序能够早期改善创伤性休克患者的凝血功能,减少术后患者的输血量,提高创伤患者生存率.%Objective To investigate the prognosis and clinical value of massive transfusion protocols in patients with traumatic shock.Methods According to the massive transfusion protocols (MTP) established by our hospital,the mortality and death causes of 76 patients with severe multiple trauma were analyzed.Prothrombin time (PT) ,activated partial thromboplastin time (APTT) ,hemoglobin (Hb) and platelet(PLT) at pre-MTP,l hours,24 hours and 7 days after MTP were dynamically monitored.The use of blood products before and after MTP also was analyzed.Results Nine (11.8%) patients died of uncontrolled bleeding.PT and APTT were 1.5 times higher than normal in 21 (27.6% ) patients.There was remarkable difference in PT ,APTT,Hb,PLT between before MTP and 1 hour after MTP(0P<0.01 ),but no remarkable difference between 1 hour after MTP and 24 hours after MTP (P >0.05) ;there was also notable difference between 7 days after MTP and 24 hours after MTP(P <0.01).After the termination of MTP,46(86.7% ) patients continued to receive blood products ,with average PRBC of 3.6 U and FFP of 5.5 U.Conclusion MTP can improve trauma patients ' coagulation function ,reduce blood transfusions and improve trauma patients' survival rate.