新鮮冰凍血漿與紅細胞懸液不同比例輸注對消化道出血患者凝血功能的影響

陳瑜　魏建

[摘要] 目的 探討消化道大出血患者輸注不同比例新鮮冰凍血漿與紅細胞懸液對患者凝血功能的影響。 方法 選取消化道大出血患者50例，依據新鮮冰凍血漿與紅細胞懸液輸注比例分為低比例血漿組17例、中比例血漿組21例、高比例血漿組12例。監測輸血前后患者凝血功能指標變化情況。 結果 三組不同比例血漿-紅細胞懸液輸注組患者輸血前凝血功能指標比較，差異無統計學意義。而大量輸注血漿和紅細胞懸液后，低比例血漿組患者APTT、PT均顯著延長，Fbg水平降低，差異均有統計學意義（P<0.05）；高比例血漿組APTT和PT也有所延長，但延長時間短于低比例血漿組，Fbg濃度也有所降低，同樣減少幅度低于低比例血漿組患者，差異均有統計學意義（P<0.05）；而中比例血漿組患者其APTT、PT和Fbg與輸血前相比無明顯變化，差異無統計學意義（P>0.05）。 結論 消化道大出血患者在臨床輸血時，應避免血漿和紅細胞懸液比例失調，低比例血漿可誘發血液低凝現象產生，以血漿∶紅細胞懸液為1∶1較好。

[關鍵詞] 消化道大出血；血漿；紅細胞懸液；凝血功能；低比例

[中圖分類號] R573.2 [文獻標識碼] B [文章編號] 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，需大量輸血快速擴充血容量，以維持血壓[1]。但短時間大量輸注成分血往往會導致患者凝血功能障礙，誘發患者死亡[2]。因此，及時有效地監測大量輸血患者凝血功能顯得至關重要，而探討血漿和紅細胞懸液適當比例輸注尤為關鍵。據此，本研究通過檢測不同比例血漿與紅細胞懸液對消化道大出血患者凝血功能的影響，得出其輸血時最佳輸注比例。

1 資料與方法

1.1 一般資料

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