围手术期FFP和RBC输注比例对大量输血患者生存状况的影响

摘要

目的 研究围手术期新鲜冰冻血浆(FFP)和红细胞(RBC)输注比例对大量输血患者生存状况的影响.方法 选取2015年1月至2016年8月新疆维吾尔自治区职业病医院收治的围手术期大量输血患者120例为研究对象,根据FFP与RBC输注比例将所有患者分为低比例组(FFP与RBC输注比例小于1:2,n=66)、中比例组[FFP与RBC输注比例为(1:2)~(1:1),n=37]、高比例组(FFP与RBC输注比例大于1:1,n=17).比较3组的一般资料,输血前后的凝血功能指标、血常规、血气分析、电解质水平,FFP、RBC、血小板血小板的输注量及预后.结果 中比例组输血后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)明显低于低比例组,纤维蛋白原(FIB)水平明显高于另外2组,差异有统计学意义(P<0.05).低比例组输血后的血红蛋白(Hb)水平明显高于另外2组,钙离子(Ca2+)水平明显高于中比例组,差异有统计学意义(P<0.05).低比例组围手术期FFP、RBC、血小板的输注量均明显低于另外2组,中比例组FFP的输注量明显低于高比例组,差异有统计学意义(P<0.05).3组的总住院时间、治愈率和病死率比较,差异无统计学意义(P>0.05).结论 对围手术期需要大量输血的患者,按照FFP与RBC输注比例为(1:2)~(1:1)进行输血,有助于预防凝血功能障碍的发生,减少输注总量,节约医疗资源,值得临床推广应用.%Objective To investigate the effect of perioperative ratio of fresh frozen plasma (FFP)to red blood cell(RBC)on sur-vival status of the patients receiving massive blood transfusion .Methods A total of 120 patients receiving perioperative massive blood transfusion in Xinjiang Uygur Autonomous Region Occupational Hospital from January 2015 to August 2016 were selected as the study subjects and divided into the low ratio group (FFP :RBC <1:2 ,n=66) ,middle ratio group(FFP :RBC was 1:2-1:1 , n=37)and high ratio group(FFP:RBC> 1:1 ,n=17)according to FFP to RBC ratio .The general data ,coagulation function inde-xes ,blood routine indexes ,blood gas analysis results ,electrolyte indexes before and after blood transfusion ,infusion amounts of FFP ,RBC and platelet(PLT) ,and prognosis were compared among 3 groups .Results The prothrombin time(PT)and activated partial thrombin time(APTT)after blood transfusion in the middle ratio group were significantly lower than those in the low ratio group ,while the fibrinogen(FIB)level was significantly higher than that in the other two groups ,the difference was statistically sig-nificant(P<0 .05) .The hemoglobin(Hb)level after blood transfusion in the low ratio group was significantly higher than that in the other two groups ,the calcium ion(Ca2+ )level was significantly higher than that in the middle ratio group ,the difference was statisti-cally significant(P<0 .05) .The perioperative infusion amounts of FFP ,RBC and PLT in the low ratio group were significantly low-er than those in the other two groups ,the FFP infusion amounts in middle ratio group was significantly lower than those in high ra-tio group ,the difference was statistically significant (P<0 .05) .There were no statistically significant differences in hospital stay , cure rate and mortality rate among the three groups (P> 0 .05) .Conclusion For the patients needing massive blood transfusion during perioperative period ,blood transfusion according to the ratio of FFP to RBC of 1:2-1:1 can conduce to prevent blood co-agulation dysfunction occurrence ,reduces infusion total amount ,saves medical resources ,which is worthy of clinical popularization and application .