大量输血时血浆与红细胞的比例探讨

本研究通过回顾性分析大量输血对患者凝血功能的影响，探讨新鲜冰冻血浆与红细胞的合适比例。2011年1月-2013年1月，因各种原因需要大量输血的患者151例，按照凝血功能正常与否，分为凝血功能正常组（138例）和凝血功能异常组（13例），以新鲜冰冻血浆与红细胞之比为1：1作为分界，每组均分为高血浆（2：1）、中血浆（1：1）、低血浆（〈1：1）3个比例组。输血前和大量输血后24h检测凝血功能。结果表明，大量输血24h后，凝血功能正常组的低血浆组凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）明显延长，纤维蛋白原（FIB）含量明显降低（均P〈0．05）；高、中血浆组凝血功能无明显变化（P〉0．05）；凝血功能异常组的中血浆和低血浆组在大量输血后凝血酶原时间、活化部分凝血活酶时间、凝血酶时间，纤维蛋白原仍在异常水平（P〉0．05），高比例组的凝血功能明显改善（P〈0．05）。结论：大量输血时，血浆与红细胞比例应根据患者凝血功能进行调整，凝血功能异常的患者建议新鲜冰冻血浆与红细胞的比例为2：1，以改善患者的凝血功能，减少不良事件的发生；凝血功能正常的患者建议冰冻血浆与红细胞的比例为1：1，减少稀释性凝血功能障碍和高血容量的发生。

Ratio of Erythrocyte and Plasma in Massive Blood Transfusion

This study was purposed to explore the suitable ratio between fresh frozen plasma and erythrocyte by retro- spective analyzsis of coagulation in patients with massive blood transfusion. The clinical data of 151 cases with massive blood transfusion from January 2011 to January 2013 were analyzed retrospectively. According to coagulation, patients were divided into coagulation normal group （ 138 cases） and coagulation dysfunction group （ 13 cases）. Based on the ratio of 1：1 of fresh frozen plasma and erythrocyte, the patients were divided into high plasma group（2：1 ）, medium plasma group （ 1： 1 ） and low plasma （ 〈 1 ： 1 ） subgroups. Coagulation was detected before and after 24 h of massive blood transfusion. The results showed that prothrombin time（PT）, activated partial thromboplastin time（APTT） and thrombin time（TT） were prolonged, fibrinogen（FIB） level decreased significantly （all P 〈0.05 ） in the low plasma subgroup of coagulation normal group after massive blood transfusion 24 h; the high plasma and the medium plasma group of coagulation normal group had no significant changes in coagulation （ P 〉 0.05 ） ; prothrombin time, activated partial thromboplastin time, thrombin time and fibrinogen level in the medium plasma and low plasma subgroup of coagulation dysfunction group after massive transfusion was still in abnormal levels （ P 〉 0.05 ）, coagulation function in high plasma subgroup was impoved significantly （P 〈 0.05）. It is concluded that the ratio of plasma to erythrocyte should be adjusted according to the patient＇s coagulation function during massive blood transfusion, the ratio between fresh frozen plasma and erythrocyte is recommended to be 2：1 in patients of coagulation dysfunction in order to improve the patient＇s coagulation function and to reduce the incidence of adverse event, the ratio of fresh frozen plasma to erythrocyte is recomonerded to be 1 ： 1 in patients with normal coagulation so as to reduc the dilutional coagulopathy and hypervolemia of blood.