限制性输血与开放性输血对急性上消化道出血患者凝血功能、血液流变学及预后的影响

摘要 目的：探讨限制性输血与开放性输血对急性上消化道出血患者凝血功能、血液流变学及预后的影响。方法：选取2018年1月~2020年1月期间我院收治的急性上消化道出血患者80例，根据随机数字表法分为对照组（n=40）和研究组（n=40），对照组患者输血方式采用开放性输血，研究组患者输血方式采用限制性输血，比较两组患者治疗24 h后、48 h后、72 h后的止血率。统计两组患者死亡率、疗效、再出血率和不良事件发生率。比较两组治疗前、治疗72 h后的Blatchford评分及凝血功能指标：凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）以及血液流变学指标：全血黏度、血浆黏度、红细胞比容。结果：研究组治疗24 h后的止血率高于对照组（P<0.05）；两组治疗48 h后、治疗72 h后的止血率组间比较差异无统计学意义（P>0.05）。两组治疗72 h后Blatchford评分均下降，且研究组低于对照组（P<0.05）。两组治疗72 h后PT、APTT均升高，且研究组高于对照组（P<0.05）。两组死亡率比较差异无统计学意义（P>0.05）；研究组不良事件总发生率、再出血率均低于对照组（P<0.05）。研究组治疗后的临床总有效率高于对照组（P<0.05）。两组治疗72 h后全血黏度、血浆黏度、红细胞比容均升高，且研究组高于对照组（P<0.05）。结论：与开放性输血相比，急性上消化道出血患者采用限制性输血，可迅速止血，有效防止患者凝血功能紊乱及血液流变学异常，同时还可减少不良事件总发生率、再出血率，可进一步改善患者预后。

The Effect of Restrictive and Open Blood Transfusion on Coagulation, Hemorheology and Prognosis in Patients with Acute Upper Gastrointestinal Hemorrhage

ABSTRACT Objective: To explore the effect of restrictive and open blood transfusion on coagulation, hemorheology and prognosis in patients with acute upper gastrointestinal hemorrhage. Methods: 80 patients with acute upper gastrointestinal bleeding who were admitted to our hospital from January 2018 to January 2020 were selected, patients were divided into control group (n=40) and study group (n=40) according to the method of random number table. The open blood transfusion was used in the control group, and the restrictive blood transfusion was used in the study group. The mortality rate, curative effect, rebleeding rate and adverse events of the two groups were counted. The hemostasis rate of the two groups was compared at 24 hours, 48 hours and 72 hours after treatment. The Blatchford score and coagulation indexes: prothrombin time (PT) and activated partial thromboplastin time (APTT) , Hemorheology indexes: whole blood viscosity, plasma viscosity, hematocrit of the two groups were compared before and 72 hours after treatment. Results: The hemostasis rate of the study group was higher than that of the control group (P<0.05), and there were no significant differences in hemostasis rate between the two groups at 48h and 72h after treatment (P>0.05). The Blatchford score of the two groups decreased at 72 hours after treatment, and that of the study group was lower than that of the control group (P<0.05). PT and APTT increased in the two groups 72 hours after treatment, and the study group was higher than the control group (P<0.05). There was no significant difference in mortality between the two groups (P>0.05). The total incidence of adverse events and rebleeding rate in the study group were lower than those in the control group (P<0.05). The total clinical effective rate of the study group was higher than that of the control group (P<0.05). After 72 hours of treatment, the whole blood viscosity, plasma viscosity and RBC specific volume of the two groups were all increased, and the study group was higher than the control group (P<0.05). Conclusion: Compared with the open blood transfusion, the restrictive blood transfusion in the patients with acute upper gastrointestinal hemorrhage can quickly stop bleeding, effectively prevent the disorder of coagulation function, reduce the total incidence of adverse events and rebleeding rate, and further improve the prognosis of the patients.