Indications for plasma in massive transfusion
Indications for plasma in massive transfusion
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DOI：
10.1016/s0049-3848(02)00147-0
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发表时间：
2002-10-31
影响因子：
7.5
通讯作者：
Haubelt, H
中科院分区：
文献类型：
--
作者：
Hellstern, P;Haubelt, H
大量输血（NIT）的最初目的是提供晶体、胶体和贫血浆红细胞浓缩物（RCC），以维持正常血容量和氧气供应。这经常导致稀释性凝血病，其经常因体温过低、酸中毒、休克诱导的肝功能损害和弥散性血管内凝血（DIC）以及大面积伤口部位的凝血因子和血小板消耗增加而加重和加速。止血障碍严重恶化了大量输血患者的预后。因此，第二个治疗目标是根据需要及时给予血浆和血小板浓缩物，以阻止止血受损诱导的微血管出血（MVB）。密切的实验室监测，包括最低血小板计数、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和纤维蛋白原，对于识别需要治疗干预的止血疾病至关重要。当PT或APTT值超过对照组平均值的1.5倍和/或当纤维蛋白原水平低于1.0 g/l时，可假定凝血障碍促进微血管出血。需要重复快速输注10-15 ml血浆/kg体重，以显著提高凝血因子水平并实现充分止血。在快速失血的情况下，必须特别考虑获得实验室结果和准备输血用血浆的周转时间。(C)2002爱思唯尔科技有限公司。保留所有权利。
The initial aim in massive transfusion (NIT) is to supply crystalloids, colloids, and plasma-poor red cell concentrates (RCCs) to maintain normovolemia and oxygen supply. This frequently leads to dilution coagulopathy, which is frequently aggravated and accelerated by hypothermia, acidosis, shock-induced impairment of liver function and disseminated intravascular coagulation (DIC), and increased consumption of clotting factors and platelets at extensive wound sites. Disorders of hemostasis deteriorate the prognosis of massively transfused patients dramatically. Therefore, the second therapeutic objective is the timely administration of plasma and platelet concentrates as required to halt the microvascular bleeding (MVB) induced by impaired hemostasis. Close laboratory monitoring, to include as a minimum platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen, is essential to identify hemostatic disorders requiring therapeutic intervention. Coagulopathy promoting microvascular bleeding can be assumed when PT or APTT values exceed 1.5 times mean controls and/or when fibrinogen levels fall below 1.0 g/l. Repeated rapid infusion of 10-15 ml plasma per kg of body weight will be required to raise clotting factor levels significantly and to achieve adequate hemostasis. The turnaround time for obtaining laboratory results and for readying plasma for transfusion must be taken into particular consideration in cases of rapid blood loss. (C) 2002 Elsevier Science Ltd. All rights reserved.