Effect of massive blood transfusion protocol on curative effect and coagulation function of patients with multiple injuries / 中国基层医药

ABSTRACT

Objective:To explore and analyze the effect of massive transfusion protocol (MTP) in early massive transfusion and prevention of coagulation disease for patients with multiple injuries.Methods:A retrospective analysis was made in 117 patients with multiple injuries admitted to Yiwu Central Hospital from March 2015 to May 2019.According to different blood transfusion schemes, they were divided into control group(53 cases) and observation group(64 cases). The patients in the control group received routine blood transfusion scheme, and the patients in the observation group received MTP blood transfusion scheme.The changes of blood routine and coagulation function, the amount of blood loss within 24h, the amount of allogeneic blood component input, the length of hospital stay and mortality were compared between the two groups.Results:The levels of Hb, HCT and PLT in the two groups after 24h of blood transfusion were significantly higher than admission[(112.73±12.73)g/L vs.(96.74±10.28)g/L, (115.28±19.27)g/L vs.(95.37±11.47)g/L, (39.72±5.21)% vs.(31.47±4.22)%, (39.10±4.97)% vs.(30.56±4.13)%, (220.93±54.28)×10 9/L vs.(142.83±36.47)×10 9/L, (216.87±64.03)×10 9/L vs.(148.96±40.22)×10 9/L, t=7.818, 6.464, 9.844, 9.621, 9.554, 6.538, all P<0.05], but there were no statistically significant differences between the two groups( t=0.681, 1.172, 0.864, 0.746, 0.740, 1.363, all P>0.05). After 24h of blood transfusion, the time of Pt and APTT in the observation group were significantly lower than admission[(13.21±2.93)s vs.(16.28±4.26)s, (46.28±3.97)s vs.(54.37±6.42)s, t=4.705, 8.574, all P<0.05], but there were no statistically significant changes in the control group[(15.84±3.62)s vs.(16.93±5.17)s, (54.02±6.39)s vs.(55.29±7.02)s, t=0.212, 0.332, all P>0.05]. The time of Pt and APTT in the observation group after 24h of blood transfusion were significantly lower than those in the control group ( t=4.344, 8.006, all P<0.05). There were no statistically significant differences in FIB levels between the two groups[(4.30±0.48)g/L vs.(4.36±0.56)g/L, (4.41±0.58)g/L vs.(4.51±0.63)g/L, t=0.651, 0.934, all P>0.05]. There were no statistically significant differences in 24h bleeding volume and fresh frozen plasma(RBC) input between the two groups[(2 684.92±703.47)mL vs.(2 725.86±810.32)mL, (17.28±3.74)U vs.(17.02±2.95)U, t=0.293, 0.411, all P>0.05]. The input amount of red blood cell suspension(PF) and the ratio of PF RBC in the observation group were significantly higher than those in the control group[(9.28±3.27)U vs.(6.29±3.18)U, (0.55±0.12) vs.(0.39±0.10), t=4.985, 7.733, all P<0.05]. The observation group had significantly lower SOFA scores and ICU stays compared with the control group[(5.93±1.64)points vs.(7.28±2.10)points, (7.21±1.85)d vs.(9.10±2.37)d, t=3.814, 4.732, all P<0.05], and the mortality rate in the observation group was significantly lower than that in the control group[6.25%(4/64) vs.20.75%(11/53), χ 2=5.457, P<0.05]. Conclusion:The standardized rescue strategy of a large number of blood transfusion treatment schemes and the early proportion of components of blood products (erythrocyte suspension, fresh frozen plasma, platelets) can significantly improve the coagulation function of patients with multiple injuries, reduce the incidence of coagulopathy and help reduce the fatality rate of major bleeding, which is worthy of clinical promotion.