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目的探讨产后大出血患者早期大量输血时,输入新鲜冰冻血浆(FFP)和红细胞(RBC)的比例对凝血功能的影响。方法因产后大出血24h内需输注RBC大于10U的患者45例,按输注FFP与悬浮RBC的比例,随机分为低血浆组(A组,FFP∶RBC=1∶2.5,15例)、中血浆组(B组,FFP∶RBC=1∶1,16例)和高血浆组(C组,FFP∶RBC=1.5∶1,14例)。检测产前和输血后24h凝血功能和血常规,比较三组患者大量输血后24h内RBC和冷沉淀输入量的差异。结果三组患者产前凝血功能、血常规比较无统计学差异(P>0.05)。大量输血24h后,A组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)延长,纤维蛋白原(Fbg)含量降低(P<0.05),B、C组凝血功能无明显变化(P>0.05);三组患者大量输血后血小板计数(Plt)及血红蛋白(Hb)均降低(P<0.05),B组优于A、C组(P<0.05)。三组间24h内输注RBC和冷沉淀的量无统计学差异(P>0.05)。结论产后大出血患者输血时,FFP与RBC比例过低,可造成血液稀释性低凝,建议以1∶1比例输注为宜。
Objective To investigate the influence of the proportion of fresh frozen plasma (FFP) and erythrocyte (RBC) on the coagulation function in the early stage of massive blood transfusion in patients with postpartum hemorrhage. Methods Forty-five patients with intra-arterial infusion of RBC greater than 10 U due to post-partum hemorrhage were randomly divided into low plasma group (group A, FFP: RBC = 1: 2.5, 15 cases) (Group B, FFP: RBC = 1: 1, 16 cases) and high plasma group (group C, FFP: RBC = 1.5: 1,14 cases). The pre-natal and post-transfusion 24h clotting function and blood routine were tested. The differences of RBC and cold-sediment input between the three groups were compared within 24 h after blood transfusion. Results There was no significant difference in prenatal coagulation function and blood routine among the three groups (P> 0.05). After a large amount of blood transfusion for 24h, the prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fbg) content in group A were decreased (P <0.05) (P <0.05). The platelet counts (Plt) and hemoglobin (Hb) in the three groups were significantly decreased after transfusion (P <0.05), and those in group B were better than those in group A and C (P <0.05). There was no significant difference in the amount of RBC and cryoprecipitate between the three groups within 24h (P> 0.05). Conclusions In the case of blood transfusions in patients with postpartum hemorrhage, the ratio of FFP to RBC is too low, which may result in low blood thinning. It is advisable to use a 1: 1 ratio infusion.