本文選題：凝血功能障礙 + 產(chǎn)后出血��； 參考：《中國輸血雜志》2016年06期

【摘要】：目的分析新鮮冰凍血漿、冷沉淀和血小板(Plt)在搶救并發(fā)凝血功能障礙的產(chǎn)后出血病例中所發(fā)揮的作用。方法根據(jù)入組及排除標(biāo)準(zhǔn),回顧性收集本院2012年11月-2015年7月全部17例伴有凝血功能障礙的產(chǎn)后出血病例。通過對(duì)產(chǎn)前、搶救前及搶救成功后2 h凝血酶原時(shí)間(PT)、活化部分凝血活酶時(shí)間(APTT)、纖維蛋白原(FIB)和Plt計(jì)數(shù)的分析,判斷導(dǎo)致凝血功能障礙所缺乏的主要凝血成分,同時(shí)分析各類血液成分輸注在修復(fù)凝血功能方面所發(fā)揮的作用。入組研究的17例患者,輸注紅細(xì)胞制品17例,輸注新鮮冰凍血漿15例,輸注冷沉淀13例,輸注血小板8例。紅細(xì)胞、新鮮冰凍血漿、冷沉淀均在搶救早期進(jìn)行輸注,血小板輸注時(shí)間相對(duì)滯后。結(jié)果入組病例搶救前PT、APTT、FIB和Plt數(shù)值均較產(chǎn)前有改變。搶救前APTT延長達(dá)到輸血臨界值(參考區(qū)間中值1.5倍)的有13例,其明顯高于Plt降低至輸血臨界值(50×109/L)的2例(P0.001);搶救前與搶救成功后2 h凝血相關(guān)指標(biāo)對(duì)比分析顯示,反映凝血因子指標(biāo)的APTT和FIB變化分別有統(tǒng)計(jì)學(xué)差異(t=4.09,P0.01;t=5.88,P0.01;),而Plt無統(tǒng)計(jì)學(xué)差異(t=1.28,P=0.22)。結(jié)論產(chǎn)后凝血功能障礙主要是因凝血因子消耗性缺乏所致。及早輸入足量含有各類凝血因子的新鮮冰凍血漿或冷沉淀,是重建凝血功能的關(guān)鍵。
[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.
【作者單位】： 湖南省長沙市中心醫(yī)院輸血科;湖南省長沙市中心醫(yī)院藥學(xué)部;湖南省長沙市中心醫(yī)院婦產(chǎn)科;
【分類號(hào)】：R714.461;R457.1

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