摘要
目的:探究大量输血患者凝血功能和纤溶系统指标变化及临床意义。方法:收集急性创伤大量输血患者89例(观察组),并将纳入同期健康体检者31例作为健康对照组。比较观察组输血前、输血1 d后与健康对照组凝血功能和纤溶系统指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血小板计数(PLT)]差异;根据观察组入院7 d内生存情况分为预后良好组、预后不良组,记录预后良好组及预后不良组输血1 d后外周血PT、APTT、TT、FIB、PLT差异,并使用受试者工作特征曲线(ROC曲线)评估输血1 d后外周血PT、APTT、TT、FIB、PLT对大量输血不良预后的预测价值。结果:输血1 d后,观察组外周血PT、APTT、TT均较输血前升高(P<0.05),FIB、PLT则较输血前降低(P<0.05);且观察组输血前、输血1 d后外周血PT、APTT、TT均高于健康对照组(P<0.05),FIB、PLT均低于健康对照组(P<0.05)。入院7 d内,89例观察组患者生存68例(76.40%),纳入预后良好组;死亡21例(23.60%),纳入预后不良组;两组性别、年龄、致伤原因及输血前外周血PT、APTT、TT、FIB、PLT比较,差异无统计学意义(P>0.05);预后不良组入院时ISS评分及输血1 d后外周血PT、APTT、TT高于预后良好组(P<0.05),输血1 d后FIB、PLT则较预后良好组低(P<0.05)。经ROC曲线分析,发现输血1 d后外周血PT、APTT、TT、FIB、PLT均对大量输血不良预后具有较高预测价值(P<0.05),其cut-off值分别为21.900 s、53.550 s、28.450 s、1.395 g/L、64.500×109/L。结论:大量输血能加剧机体凝血纤溶系统紊乱,输血后外周血PT、APTT、TT、FIB、PLT水平与患者近期预后相关,可辅助临床判断患者近期生存情况。
Objective:To explore the changes and clinical significance of coagulation function and fibrinolytic system indexes in patients with massive blood transfusion.Methods:89 case of acute trauma patients with massive blood transfusion(observation group)and 31 healthy people who underwent physical examination(healthy control group)during the same period were selected.The coagulation function and fibrinolytic system indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),platelet count(PLT)]were compared before transfusion and 1 day after transfusion between the two groups.According to the survival condition within 7 days after admission,the observation group was divided into good prognosis group and poor prognosis group.The PT,APTT,TT,FIB and PLT in peripheral blood after 1 day of transfusion were recorded and compared between good prognosis group and poor prognosis group.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of PT,APTT,TT,FIB and PLT for the poor prognosis of massive blood transfusion after 1 day of transfusion.Results:After 1 day of transfusion,the PT,APTT and TT in peripheral blood in observation group were all increased compared with those before transfusion(P<0.05),while FIB and PLT were decreased compared with those before transfusion(P<0.05).The PT,APTT and TT in peripheral blood in observation group before transfusion and after 1 day of transfusion were all higher than those in healthy control group(P<0.05),while the FIB and PLT were lower than those in healthy control group(P<0.05).Within 7 days after admission,among 89 patients in observation group,68 patients(76.40%)survived and were included in good prognosis group,and 21 patients(23.60%)died and were included in poor prognosis group.There were no statistically significant differences in gender,age,cause of injury and PT,APTT,TT,FIB and PLT in peripheral blood before transfusion between good prognosis group and poor prognosis group(P>0.05).ISS score at admission and PT,APTT and TT in peripheral blood after 1 day of transfusion in poor prognosis group were higher than those in good prognosis group(P<0.05),while FIB and PLT after 1 day of transfusion were lower than those in good prognosis group(P<0.05).According to ROC curve analysis,it was found that PT,APTT,TT,FIB and PLT in peripheral blood had high predictive value for poor prognosis of massive blood transfusion after 1 day of transfusion(P<0.05),and the cut-off values were 21.900 second,53.550 second,28.450 second,1.395 g/L and 64.500×109/L.Conclusion:Massive blood transfusions can aggravate the disorder of body’s coagulation and fibrinolytic system.The levels of PT,APTT,TT,FIB and PLT in peripheral blood after transfusion are related to the short-term prognosis,which can help clinical judgment of short-term survival.
作者
薛乐
闫晓琴
王秋艳
XUE Le;YAN Xiaoqin;WANG Qiuyan(Department of Laboratory,Yan’an People’s Hospital,Shaanxi Province,Yan’an 716000)
出处
《陕西医学杂志》
CAS
2020年第10期1343-1346,共4页
Shaanxi Medical Journal
基金
陕西省卫生和计划生育委员会科研项目(2015JM12074)。
关键词
大量输血
凝血功能
纤溶系统
急性创伤
预后
Massive blood transfusion
Coagulation function
Fibrinolytic system
Acute trauma
Prognosis
作者简介
通讯作者:王秋艳。
