【摘要】 目的探讨老年严重创伤患者大量输血时动态监测凝血指标的价值。方法选自该院于2015年1月至2017年9月收治的老年严重创伤患者107例,按照输血要求分为大量输血组56例与一般输血组51例。两组患者均于入院后采用常规治疗,大量输血组给予患者大量输血,一般输血组给予患者一般输血。比较两组输血前、输血1d和输血3d凝血功能指标和电解质变化,及多器官功能障碍综合征(MODS)发生和致死情况。结果大量输血组输血1d和3d患者血小板(PLT)、血浆纤维蛋白原(Fib)下降而凝血酶原时间(PT)、部分凝血活酶时间(APTT)和凝血酶时间(TT)升高,差异有统计学意义(P<0.05);而一般输血组输血1d和3d患者PLT、Fib、PT、APTT和TT水平变化比较,差异无统计学意义(P>0.05);大量输血组输血1d和3d患者PLT、Fib低于一般输血组,而PT、APTT和TT高于一般输血组,差异有统计学意义(P<0.05)。两组输血1d患者K~+、Na~+变化比较,差异无统计学意义(P>0.05);两组输血3d患者K~+水平升高而Na~+水平下降,差异有统计学意义(P<0.05);大量输血组输血3d患者K~+水平高于一般输血组而Na~+水平低于一般输血组,差异有统计学意义(P<0.05)。大量输血组MODS发生率高于一般输血组,且差异有统计学意义(P<0.05);大量输血组病死率高于一般输血组,但差异无统计学意义(P>0.05)。结论老年严重创伤患者大量输血可恢复血容量,但会造成凝血功能异常,故而大量输血时动态监测凝血功能具有重要意义。更多还原

【Abstract】 Objective To investigate the value of dynamic monitoring of coagulation parameters in elderly patients with severe trauma undergoing massive blood transfusion.Methods 107 elderly patients with severe trauma admitted in our hospital from January 2015 to September-2017 were divided into massive transfusion group(56 cases)and general blood transfusion group(51 cases)according to the requirements of blood transfusion.Two groups of patients were treated with conventional treatment after admission,a large number of blood transfusion group given a large number of blood transfusion,general blood transfusion group given general blood transfusion.Blood transfusion 1 dand blood transfusion 3 dcoagulation function index and electrolyte changes were compared between the two groups,and the occurrence and mortality of MODS were observed.Results blood transfusion group blood transfusion of 1 dand 3 din patients with PLT,PT,APTT and Fib decreased and TT increased,the difference was statistically significant(P<0.05);and no significant differences between the general 1 dand 3 din patients with blood transfusion group PLT,Fib,PT,APTT and TT content(P>0.05);massive blood transfusion group blood transfusion of 1 dand 3 din patients with PLT and Fib below the general transfusion group and PT,APTT and TT higher than normal blood transfusion group,the difference was statistically significant(P <0.05).No significant differences between the two groups of patients with 1 dK~+and Na~+in blood transfusion(P>0.05);two groups of blood transfusion in patients with 3 delevated K~+concentration and Na~+concentration decreased,the difference was statistically significant(P<0.05);group 3 dpatients with massive blood transfusion blood transfusion group and the concentration of K~+was higher than that of general Na~+concentration is lower than the general blood transfusion group,the difference was statistically significant(P<0.05).The incidence of MODS in the massive transfusion group was higher than that in the general transfusion group,the difference was statistically significant(P<0.05).The mortality of the massive transfusion group was higher than that of the general transfusion group,but there was no statistical difference(P>0.05).Conclusion large amount of blood transfusion can restore blood volume in elderly patients with severe trauma,but it will cause abnormal coagulation function,so it is important to monitor blood coagulation function dynamically by massive transfusion.更多还原