新鲜冰冻血浆、冷沉淀和血小板在抢救并发凝血功能障碍产后出血中的作用分析

发布时间：2018-04-24 15:27

本文选题：凝血功能障碍 + 产后出血　；参考：《中国输血杂志》2016年06期

【摘要】：目的分析新鲜冰冻血浆、冷沉淀和血小板(Plt)在抢救并发凝血功能障碍的产后出血病例中所发挥的作用。方法根据入组及排除标准,回顾性收集本院2012年11月-2015年7月全部17例伴有凝血功能障碍的产后出血病例。通过对产前、抢救前及抢救成功后2 h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和Plt计数的分析,判断导致凝血功能障碍所缺乏的主要凝血成分,同时分析各类血液成分输注在修复凝血功能方面所发挥的作用。入组研究的17例患者,输注红细胞制品17例,输注新鲜冰冻血浆15例,输注冷沉淀13例,输注血小板8例。红细胞、新鲜冰冻血浆、冷沉淀均在抢救早期进行输注,血小板输注时间相对滞后。结果入组病例抢救前PT、APTT、FIB和Plt数值均较产前有改变。抢救前APTT延长达到输血临界值(参考区间中值1.5倍)的有13例,其明显高于Plt降低至输血临界值(50×109/L)的2例(P0.001);抢救前与抢救成功后2 h凝血相关指标对比分析显示,反映凝血因子指标的APTT和FIB变化分别有统计学差异(t=4.09,P0.01;t=5.88,P0.01;),而Plt无统计学差异(t=1.28,P=0.22)。结论产后凝血功能障碍主要是因凝血因子消耗性缺乏所致。及早输入足量含有各类凝血因子的新鲜冰冻血浆或冷沉淀,是重建凝血功能的关键。
[Abstract]:Objective to analyze the role of fresh frozen plasma, cryoprecipitation and platelets Plt in rescuing postpartum hemorrhage complicated with coagulation dysfunction. Methods according to the criteria of admission and exclusion, 17 cases of postpartum hemorrhage with coagulation dysfunction were collected retrospectively from November 2012 to July 2015. Based on the analysis of prothrombin time (PTT), activated partial thromboplastin time (APTT), fibrinogen (FIBB) and Plt count before, before and 2 hours after successful rescue, the main coagulation components that lead to coagulation dysfunction were judged. At the same time, the function of various kinds of blood component infusion in repairing coagulation function was analyzed. Among the 17 patients, 17 were infused with red blood cell products, 15 with fresh frozen plasma, 13 with cryoprecipitation and 8 with platelets. Red blood cells, fresh frozen plasma and cryoprecipitation were all infused in the early stage of rescue. Results the FIB and Plt values of PTT APTTT before rescue were all changed compared with those before delivery. There were 13 cases whose APTT prolonged to the critical value of blood transfusion (1.5 times of the reference interval) before rescue, which was significantly higher than that of 2 cases whose Plt decreased to the critical value of blood transfusion (50 脳 10 9 / L) (P 0.001). The changes of APTT and FIB reflecting coagulation factor were significantly different (P = 4.09, P 0.01, P = 5.88, P 0.01), but no significant difference was found in Plt (t = 1.28, P = 0.22, P = 0.22). Conclusion postpartum coagulation dysfunction is mainly due to the deficiency of coagulation factor consumption. Early infusion of fresh frozen plasma or cryoprecipitation containing all kinds of coagulation factors is the key to reconstruct coagulation function.
【作者单位】：湖南省长沙市中心医院输血科;湖南省长沙市中心医院药学部;湖南省长沙市中心医院妇产科;
【分类号】：R714.461;R457.1

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