摘要
目的了解血液制剂对不同程度创伤性脑损伤患者预后的影响。方法通过回顾性分析收集本院2012年1月—2022年12月的621例创伤性脑损伤患者临床资料,按照格拉斯哥昏迷评分法(GCS)将输血患者分为重度意识障碍(GCS 3~8分,n=302)、中度意识障碍(GCS 9~12分,n=186)、轻度意识障碍(GCS 13~14分,n=133)3个组,对其一般临床资料及实验室检查指标进行分析;以住院死亡率作为生存结局指标将患者分为死亡组(n=72)及未死亡组(n=549)2个组,不同血液制剂输注量对创伤性脑损伤患者预后的影响使用单因素及多因素Logistic回归分析,红细胞(RBC)输注量评估创伤性脑损伤患者预后价值使用ROC曲线。结果GCS 3~8分的患者在住院天数(21.73±15.89 vs 20.83±11.54 vs 15.5±7.76)d和RBC输注量(6.16±6.79 vs 4.67±2.81 vs 3.67±3.20)U显著高于其他2组(P<0.05);创伤性脑损伤患者末次输血后的NLR、PCT、CRP、PT、Fib、FDP、DDI相较于首次输血前的存在显著差异(P<0.05);死亡组患者RBC输注量、血浆输注量、PLT输注量及冷沉淀输注量均显著高于未死亡组(P<0.05),单因素(OR:1.541,95%CI:1.412~1.682)及多因素(OR:1.522,95%CI:1.362~1.700)Logistic回归分析显示RBC输注量是影响创伤性脑损伤患者输注血液制剂后预后因素的危险因素;ROC曲线分析显示,RBC输注量可作为评估创伤性脑损伤患者预后的指标(敏感度为0.708,特异度为0.812)。结论血液制剂输注会影响不同程度创伤性脑损伤患者炎症及凝血指标的改变,且RBC输注量可用于创伤性脑损伤患者预后的评估。
Objective To investigate the effects of blood component transfusion on the prognosis of patients with varying severity of traumatic brain injury(TBI).Methods A retrospective analysis was conducted on clinical data from 621 TBI patients admitted between January 2012 and December 2022.The patients in the blood transfusion group were categorized into three groups based on Glasgow Coma Scale(GCS)scores:severe impairment(GCS 3-8,n=302),moderate impairment(GCS 9-12,n=186),and mild impairment(GCS 13-14,n=133).General clinical data and laboratory test indexes were analyzed.Patients were further divided into two subgroups based on in-hospital mortality:death group(n=72)vs survival group(n=549).Univariate and multivariate logistic regression analysis was used to analyze the effects of different blood component transfusion volumes on the prognosis of TBI patients.ROC curve was used to evaluate the prognostic value of red blood cell transfusion volume.Results Patients with GCS scores 3-8 had significantly longer hospital stays(21.73±15.89 vs 20.83±11.54 vs 15.5±7.76)and higher RBC transfusion volumes(6.16±6.79 vs 4.67±2.81 vs 3.67±3.20)than the other two groups(P<0.05).NLR,PCT,CRP,PT,Fib,FDP and DDI after the last transfusion showed significant differences from pre-transfusion values(P<0.05).The death group exhibited higher transfusion volumes of RBCs,plasma,platelets,and cryoprecipitate compared with the survival group(P<0.05).Univariate(OR:1.541,95%CI:1.412-1.682)and multivariate(OR:1.522,95%CI:1.362-1.700)logistic regression analyses showed that the RBC transfusion volume was a risk factor affecting the prognostic factors of TBI patients after infusion of blood components.ROC curve analysis showed that RBC transfusion volume could serve as a prognostic marker(sensitivity:0.708,specificity:0.812).Conclusion Blood component transfusion alters inflammatory and coagulation markers in patients with different degrees of TBI,and RBC transfusion volume is a viable prognostic indicator for TBI outcomes.
作者
姚祺敏
陈诚
王志成
夏荣
YAO Qimin;CHEN Cheng;WANG Zhicheng;XIA Rong(Department of Transfusion Medicine,Affiliated Huashan Hospital of Fudan University,Shanghai 200040,China)
出处
《中国输血杂志》
2025年第6期777-781,共5页
Chinese Journal of Blood Transfusion
基金
国家自然科学基金面上项目(82370232)。
关键词
创伤性脑损伤
炎症
凝血功能
血液制剂输注
traumatic brain injury
inflammation
coagulation
transfusion of blood component
作者简介
第一作者:姚祺敏(1989-),男,技师,Email:358887866@qq.com;通信作者:夏荣,Email:xiarongcn@126.com。
