不同血浆和红细胞比例对严重创伤患者血K+与Ca2+水平及生存周期的影响

目的 探讨不同冰冻血浆和红细胞比例对严重创伤患者血K⁺、Ca²⁺水平及生存周期的影响,为严重创伤患者的临床治疗提供参考依据。方法 回顾性分析92例严重创伤患者的临床资料,据入院后24 h内输注新鲜冰冻血浆与悬浮红细胞比例不同分为高、中、低3组,高比例组(血浆∶红细胞≥1∶1)40例,中比例组(血浆∶红细胞=1∶2～1∶1)25例,低比例组(血浆∶红细胞≤1∶2)27例。比较3组患者输注血制品情况、输血前后K⁺、Ca²⁺浓度、凝血功能,统计死亡率及死亡患者平均生存周期。结果 中、低比例组患者住院期间悬浮红细胞输注总量均大于高比例组(P＜0.05或P＜0.01),但中、低比例组两组间无明显差异(P＞0.05)。与输血前比较,输血后3组患者血K⁺、Ca²⁺浓度均降低(P＜0.05或P＜0.01),但3组间无明显差异(P＞0.05)。与输血前比较,输血后低比例组患者PT、APTT延长,INR增加(P＜0.01),高、中比例组患者输血前后PT、APTT、INR无明显变化(P＞0.05),且均短于/小于低比例组(P＜0.01)。3组死亡率及患者平均生存周期均无明显差异(P＞0.05)。结论 新鲜冰冻血浆∶悬浮红细胞≤1∶2大量输血后患者凝血功能明显异常,大量输血后患者血K⁺、Ca²⁺浓度均降低,但不同血浆和红细胞比例对血K⁺、Ca²⁺浓度及生存周期无明显影响。

Effects of different ratios of plasma to erythrocyte on blood K+,Ca2+ levels and life cycle of patients with severe trauma

Objective To investigate the effect of different ratio of frozen plasma and red blood cells on blood K⁺,Ca²⁺ levels and life cycle of patients with severe trauma,in order to provide reference for the clinical treatment of patients with severe trauma.Methods 92 patients with severe trauma were analyzed retrospectively.According to the different ratio of fresh frozen plasma to erythrocyte infused within 24 h after admission,they were divided into three groups:high,middle and low proportion.40 cases in the high proportion group(plasma: erythrocyte≥1∶1),25 cases in the middle proportion group(plasma:erythrocyte=1∶2～1∶1),and 27 cases in the low proportion group (plasma: erythrocyte≤1∶2).Blood products,K⁺,Ca²⁺ concentration before and after blood transfusion,coagulation function,average mortality and life cycle of the three groups were compared.Results The total amount of suspended erythrocyte transfusion in the middle and the low proportion groups was larger than that in the high proportion group(P＜0.05 or P＜0.01),but there was no significant difference between the middle and the low proportion groups(P＞0.05).Compared with before blood transfusion,blood K⁺ and Ca²⁺ concentrations in the three groups were decreased after blood transfusion (P＜0.05 or P＜0.01),but there was no significant difference among the three groups (P＞0.05).Compared with before blood transfusion,Pt and APTT were prolonged in the low proportion group after transfusion,while INR was increased(P＜0.01),and Pt,APTT and INR had no significant change in the high proportion group and the middle proportion group before and after blood transfusion(P＞0.05),and all of them were shorter or less than the low proportion group(P＜0.01).There was no significant difference in mortality and average life cycle among the three groups(P＞0.05).Conclusion The coagulation function of patients with fresh frozen plasma: suspended erythrocyte≤1∶2 was significantly abnormal after massive blood transfusion.The concentration of blood K⁺ and Ca²⁺ decreased after massive transfusion.However,the concentration of blood K⁺,Ca²⁺ and the life cycle were not significantly affected by the different ratio of plasma to erythrocyte.