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目的:探讨严重创伤患者大量输血时动态监测凝血指标的临床意义。方法:选择2012年6月至2015年6月收治的136例创伤患者为研究对象,按照输血要求分为大量输血组(67例)和少量输血组(69例),分别于输血前(T0)、输血后1 d(T1)、输血后3 d(T2)、输血后5 d(T3)采集患者全血3 ml,检测两组患者各时段凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原含量(FIB)及血小板计数(PLT)。结果:输血前大量输血组和少量输血组PT、APTT、TT、FIB、PLT比较差异无统计学意义(P>0.05),少量输血组输血前后PT、APTT、TT、FIB、PLT比较差异无统计学意义(P>0.05)。大量输血组T1时PT、APTT、TT显著高于T0时,FIB显著低于T0时,至T2、T3时均恢复至T0时水平;T1时PT、APTT、TT显著高于T0、T2、T3时,FIB显著低于T0、T2、T3时(P<0.05),T0、T2、T3时PT、APTT、TT、FIB比较差异无统计学意义(P>0.05);PLT至T1时降低至最低水平,此后逐渐上升,但至T2、T3时PLT均低于T0时(P<0.05)。结论:严重创伤患者大量输血时会导致凝血功能异常,动态监测凝血功能,并适当补充血小板或一定比例血浆能够改善患者凝血功能。
Objective: To investigate the clinical significance of dynamic monitoring of coagulation index in severe trauma patients during massive blood transfusion. Methods: One hundred and sixty-six trauma patients admitted from June 2012 to June 2015 were selected and divided into a large number of blood transfusions (67 cases) and a small number of transfusions (69 cases) according to the requirements of transfusion. Blood samples were collected before transfusion (T0) (T1), 3 days after blood transfusion (T2), and 5 days after blood transfusion (T3), 3 ml of whole blood were collected. Prothrombin time (PT), prothrombin Time (APTT), thrombin time (TT), fibrinogen content (FIB) and platelet count (PLT). Results: There was no significant difference in PT, APTT, TT, FIB and PLT between transfusion group and transfusion group before transfusion (P> 0.05). There was no statistical difference in PT, APTT, TT, FIB and PLT before and after transfusion Significance (P> 0.05). The levels of PT, APTT and TT were significantly higher in Tl group than those in T0 group, while those in FIB group were significantly lower than those in T0 group (P <0.05). There was no significant difference in PT, APTT, TT and FIB between T0, T2 and T3 (P> 0.05). The PLT decreased to the lowest at T1 Level, then gradually increased, but by the time of T2 and T3 PLT were lower than T0 (P <0.05). Conclusion: A large number of patients with severe trauma can lead to abnormal coagulation function, dynamic monitoring of coagulation function, and appropriate platelet or a certain proportion of plasma can improve the coagulation function of patients.