神经外科手术中大量输血患者红细胞压积及凝血状态研究

摘要 目的：探讨神经外科手术中大量输血患者采用不同输血方法对红细胞压积及凝血状态的影响。方法：选择2017年2月至2019年12月在本院进行手术的神经外科患者104例，根据随机数字表法把患者分为观察组与对照组各52例。观察组给予自体输血治疗，对照组给予异体输血治疗，记录和比较患者红细胞压积及凝血状态变化情况。结果：所有患者都完成手术，两组的手术时间、术中输血量与补液量对比差异无统计学意义(P>0.05)。两组术后1 d的红细胞压积低于术前1 d(P<0.05)，组间手术前后对比差异都无统计学意义(P>0.05)。两组术后1 d的凝血酶原时间(prothombin time，PT)与活化部分凝血活酶时间(activited partial thomboplastin time，APTT)值高于术前1 d(P<0.05)，组间手术前后对比差异都无统计学意义(P>0.05)。观察组输血后7 d的感染发生率为1.9 %，显著低于对照组的15.4 %(P<0.05)。结论：神经外科手术中大量输血中采用自体输血并不会影响患者的红细胞压积与凝血状态，不会增加输血难度与输血量，但能有效减少感染等不良反应。

A Study on the Hematocrit and Coagulation Status of Patients with Massive Blood Transfusion in Neurosurgery

ABSTRACT Objective: To investigate the effects of different blood transfusion methods on the hematocrit and coagulation status of patients udergoing in a large number of blood transfusion during neurosurgery. Methods: From February 2017 to December 2019, 104 cases of patients treated by neurosurgery in our hospital were selected and divided into the observation group and control group, according to the random number table method, with 52 cases in each group. The observation group was given autologous blood transfusion therapy, and the control group was given allogeneic blood transfusion therapy. The changes in hematocrit and coagulation status of the patients were compared. Results: All patients completed the operation. There was no significant difference in the operation time, intraoperative blood transfusion volume and fluid replacement volume between the two groups (P>0.05). The hematocrit at 1 day after operation in both groups were lower than that at 1 day before operation (P<0.05), and there was no significant difference between the two groups before and after operation(P>0.05). The PT and APTT values at 1d after operation in two groups were higher than those at 1d before operation(P<0.05), and there was no significant difference compared between the two groups before and after operation (P>0.05). The incidence rates of infection in the observation group at 7 days after blood transfusion was 1.9 %, which was significantly lower than that in the control group(15.4 %, P<0.05). Conclusion: Autologous massive transfusion in neurosurgery shows little affect on the hematocrit and coagulation status of patients, it also does not increase the difficulty and volume of blood transfusion, but it can effectively reduce the occurrence of adverse reactions such as infection.