2020 年第 12 期 第 15 卷

大量输血对老年严重创伤患者凝血功能和电解质平衡的影响

Effects of massive blood transfusion on coagulation function and electrolyte in elderly patients suffering severe trauma

作者：王莹1李志静1殷翔2

英文作者：Wang Ying1 Li Zhijing1 Yin Xiang2

单位：1辽宁中医药大学附属医院输血科，沈阳110032；2陆军特色医学中心创伤科，重庆400038

英文单位：1Department of Blood Transfusion Affiliated Hospital of Liaoning University of Traditional Chinese Medicine Shenyang 110032 China; 2Department of Trauma， Army Characteristic Medical Center Chongqing 400038 China

关键词：严重创伤；大量输血；凝血功能；老年人

英文关键词：Severetrauma;Massivebloodtransfusion;Coagulationfunction;Elderly

• 摘要：

• 目的 探讨大量输血对老年严重创伤患者凝血功能和钠、钾离子水平的影响。方法 收集辽宁中医药大学附属医院2015年1月至2019年3月收治的老年严重创伤患者108例病历资料，根据输血量分为大量输血组（58例）和一般输血组（50例）。比较2组患者输血前和输血1、3 d后凝血功能和钠、钾离子水平，以及输血后低体温、枸橼酸中毒、凝血功能障碍等不良反应的发生情况。结果 输血前，2组患者凝血功能各项指标和钠、钾离子水平比较差异均无统计学意义（均P＞0.05）；输血1、3 d后，2组患者凝血酶原时间（PT）、凝血酶时间（TT）及活化部分凝血活酶时间（APTT）均长于输血前，且输血3 d后长于输血1 d后，钾离子水平均高于输血前，且输血3 d后高于输血1 d后，纤维蛋白原（FIB）、血小板计数（PLT）和钠离子水平均低于输血前，且输血3 d后低于输血1 d后；大量输血组输血1、3 d后PT、TT、APTT均长于一般输血组，钾离子水平高于同期一般输血组，FIB、PLT和钠离子水平低于同期一般输血组（均P＜0.05）。输血后，大量输血组输血不良反应发生率高于一般输血组［79.3%(46/58)比52.0%（26/50）］，差异有统计学意义（χ2=9.012，P=0.003）。结论 大量输血可促进老年严重创伤患者血容量恢复，但会造成凝血功能异常和电解质紊乱，故对于需大量输血患者需在输血过程中动态监测凝血功能指标和电解质水平，确保患者的生命安全。

• Objective To investigate the effects of massive blood transfusion on blood coagulation and sodium and potassium levels in elderly patients with severe trauma. Methods A total of 108 elderly patients with severe trauma admitted to the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 2015 to March 2019 were divided into massive transfusion group (58 cases) and general transfusion group (50 cases) according to the amount of transfusion. The changes of coagulation function, sodium and potassium levels were compared between the two groups before and 1 and 3 d after transfusion. The adverse reactions such as hypothermia, citrate poisoning and coagulation disturbance after blood transfusion were recorded. Results Before blood transfusion, there was no significant difference between the two groups in terms of coagulation indexes, potassium ion and sodium ion levels (all P>0.05); on the 1 and 3 d after blood transfusion, the prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT) and potassium ion levels of the two groups were higher than those before blood transfusion, and on 3 d after blood transfusion, the FIB, PLT and sodium ion levels were lower than those before blood transfusion, and on the 3 d after blood transfusion, they were lower than those on 1 d after blood transfusion; on 1 and 3 d after blood transfusion, those in massive blood transfusion group was lower than those in general transfusion group. The levels of PT, TT, APTT and potassiumion in massive transfusion group were higher than those of the general transfusion group, and the levels of FIB, PLT and sodium ion were lower than those in general transfusion group (all P<0.05). After transfusion, the incidence of adverse reactions in the massive transfusion group was higher than that in the general transfusion group ［79.3%(46/58) vs 52.0%(26/50)］, the difference was statistically significant (χ2=9.012, P=0.003). Conclusion sMassive blood transfusion can promote the recovery of blood volume in the elderly patients with severe trauma, but it will cause abnormal coagulation function. Therefore, for the patients who need massive blood transfusion, dynamic monitoring of coagulation function indicators should be carried out in the process of blood transfusion to avoid coagulation dysfunction and ensure the safety of patients′ lives.