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目的调查分析某医院近5年肝硬化患者临床资料,重点探讨冰冻血浆(frozen plasma,FP)使用现状。方法收集某医院2008年7月至2013年6月所有肝硬化住院患者的病历资料,对FP的输注原因、不同Child-Pugh分级患者FP使用情况以及输注FP前后凝血指标的变化等进行统计分析。结果共纳入肝硬化患者1 511例,其中输注FP者408例(27.0%),主要为乙型病毒性肝炎肝硬化,其次为酒精性和胆汁淤积性。408例患者共接受2 708次FP治疗,合计输注693 800 mL,每例的输注次数和输注量的中位数分别为5次和1 200 mL。首次输注FP的主要原因为改善凝血功能、支持治疗和预防性输注,分别占51.7%、30.9%和8.8%。Child-Pugh分级为C级的患者FP每例的输注量和输注次数均高于A级和B级(P<0.01)。输注FP前PT主要集中于12.1~20 s(72%),APTT主要集中于30.1~46 s(62%)。INR≤1.4的患者接受FP输注后INR未见缩短,而INR>1.8者则明显缩短。结论肝硬化患者输注FP的比例和频次均较高,可能存在一定不合理现象。肝硬化患者FP输注指征有待进一步循证学研究。
Objective To investigate and analyze the clinical data of patients with cirrhosis in a hospital in recent 5 years, and to investigate the current status of frozen plasma (FP). Methods The data of hospitalized patients with cirrhosis from July 2008 to June 2013 in a hospital were collected and the causes of FP infusion, FP use in different Child-Pugh classifications, changes of coagulation indexes before and after infusion of FP were calculated analysis. Results A total of 1 511 patients with cirrhosis were enrolled, of whom 408 (27.0%) were treated with FP, mainly cirrhosis of the liver caused by hepatitis B, followed by alcoholism and cholestasis. 408 patients received a total of 2 708 FP treatments with a total infusion of 693 800 mL with a median of 5 injections and 1 200 mL of infusion for each case. The first reason for the initial infusion of FP was improvement of coagulation, supportive care and prophylactic infusion, accounting for 51.7%, 30.9% and 8.8% respectively. Patients with Child-Pugh class C had higher amounts of transfusions and transfusions per patient per case than those at grades A and B (P <0.01). PT before infusion of FP focused on 12.1 ~ 20 s (72%), APTT mainly concentrated in 30.1 ~ 46 s (62%). Patients with INR ≤1.4 had no shortening of INR after receiving FP infusion, whereas those with INR> 1.8 significantly shortened. Conclusions The proportion and frequency of FP infusion in patients with liver cirrhosis are higher, there may be some unreasonable phenomenon. FP infusion in cirrhotic patients is subject to further evidence-based studies.