Massive Blood Transfusion On Coagulation Function In Severe Trauma Patients With Effects And Countermeasures

Objective: Trauma of modern society, "the world's first public nuisance" has been great attention at home and abroad. There is no registration system in trauma of hospital system in China, which is a more accurate understanding of the occurrence of trauma, to treat and guard against the negative. Most of the serious injury of modern trauma patients, with a large quantity of blood loss.Early massive blood transfusion is one of the principal means of treating critically ill patients,particularly in patients with hemorrhagic shock.Blood transfusion is not only used to supply and maintain blood volume, improve microcirculation, increase blood pressure with anti-shock and the prevention of hemorrhagic shock, what's more important is the supply of oxygen to red blood cells with a band in order to correct the result of red blood cells to reduce or lower their aerobic capacity caused by the acute hypoxia; and add a variety of clotting factor to correct the blood coagulation disorder.Massive blood transfusion (MT, massive transfusion) is generally defined as: (1)in 12 hours (also refer to 24 hours) within the blood transfusion which is greater than or equal to the total blood volume of patients; (2)successive blood transfusion of more than 1.5 times the patient blood volume; (3)short period of time transfuse the amount of banked blood circulation up to 3/4, or within 24 hours, the blood transfusion volume beyond 5 000 ~ 7 000ml; (4)also refers to in 6 to 8 hours to transfuse the equivalent of whole blood volume of the blood of patients. However, this massive infusion of colloidal liquid crystals and non-regular components of blood coagulation factor coagulation dysfunction can also merge, resulting in perioperative mortality, re-operation and infection rates rise.Therefore, timely and accurate evaluate the blood coagulation in massive transfusion patients ,then give appropriate treatment, which has a direct impact on the prognosis for successful treatment of great importance.The purpose of this study is to review our hospital experience with severe trauma of 13 patients whose ISS scores≥16,dating from December,2007 through December,2009. At the same time,compare their coagulation function before and after operation.To explore the effect and countermeasures of coagulation function through massive transfusion in the severe trauma patients.Methods: We collected 13 severe trauma patients with ISS scores≥16,who must be accept massive transfusion during surgery from December,2007 to December,2009. Self-designed raw data sheets for enrolled patients has been used, which recorded every patients'general information, including sex, age, ISS score, weight, history of cardiovascular and pulmonary diseases, preoperative laboratory examination results, including ECG, sternum, blood routine examination, blood clotting function, liver function and renal function. When patient went to operation room, we monitored them by apparatus, including ECG, oxygen saturation of pluse, blood interventional arerial pressure and central venous pressure. At the same time, take haemodilution of 2～3 venous channels for patient. After opening the venous channels, first infusion lactated Ringer solution and other crystalloid to maintain blood volume. Later after the beginning of surgery, when the volume of blood loss was within the 800ml,first use artificial plasma substitutes in order to supplement blood volume. When volume of blood loss reach to 1000ml in operation, we infuse concentrated red blood cell and fresh frozen plasma.Quantity of intraoperative hemoglobin maintained at (80-100) g / L or more. If the blood loss amounted to 100%,we start to infusion of platelet (l.5-2U/10kg) and cryoprecipitate (5-10U).CVP was keeped in 12-15cmH2O during the whole operation. Completed of the surgery, admitted patients to ICU with a tracheal tube or a ward. Monitoring Project: before and after the third day of immediate and post-operative monitoring of patients with prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB), platelet count (PLT), hemoglobin concentration (HGB).At the same time, monitor blood K+, Na+, Ca2+ concentration and other programme. Observe the wound oozing and wound drainage situation of patients, after put into the ICU or the ward, follow-up to the discharged patients, recording patients discharged from hospital the number of days between surgery. Statistics patients before and after the first days and 3 days ,5 days of massive transfusion whether the significant difference in coagulation function. And whether exist the contacts between the ISS score with the total volume of blood transfusion. With a view to better guide severe clinical trauma patients with massive blood transfusion, to avoid this may complications resulting.Result: (1)Massive blood transfusion after the first day compared with the preoperative, PT, APTT, TT is significantly prolonged periods (P <0.05), FIB, and PLT are significantly lower than before the blood transfusion (P <0.05).(2)Massive blood transfusion after the first day and massive blood transfusion after the third day of the comparison, PT, APTT, TT periods significantly shorter (P <0.05), FIB is significantly higher (P <0.05); massive blood transfusion after the first day and massive blood transfusion after the third day of PLT, there is a significant difference (P <0.05), but increased platelet not obvious.(3)The third day after massive blood transfusion compared with the preoperative, PT, APTT, TT time, there is no significant difference (P> 0.05), FIB is no significant difference (P> 0.05); massive blood transfusion after the first day and blood transfusion after the third day of the PLT comparison, there is a significant difference (P <0.05), platelets were still very low. Massive blood transfusion after the third day of the coagulation function can be basically restored to preoperative status. (4) The third day after massive blood transfusion compared with the fifth day, PT, APTT, TT time, there was no significant difference (P> 0.05), FIB was no significant difference (P> 0.05), the post-transfusion PLT of the third day and the fifth day of comparison, there is significant difference (P <0.05), platelets has grown dramatically. (5)The correlation between ISS scores with the total volume of blood transfusion are positively correlated, that is, as the ISS of the increase in the total blood volume also increased. Conclusion: (1) Severe trauma patients with massive blood transfusion after the first day of blood coagulation function are significantly lower than before the blood transfusion, the coagulation indicator are significantly prolonged the time than before-operation.(2) The coagulation function of severe trauma patients with massive blood transfusion improved significantly, compared transfusion after the third day with after the first day, the coagulation indicators are significantly shorter than the first day.(3) Coagulation function of massive blood transfusion in patients with severe trauma, that after three days is able to return to the preoperative state, but the platelets were still very low. (4) There is no difference and no change in coagulation function between the fifth day after and the third day of massive blood transfusion in patients with severe trauma, tending towards stability, platelet has grown dramatically. (5) ISS scores and the total blood transfusion volume has a positive correlation,as ISS increased (injury increase), total blood transfusion volume increase, cost of medical resources has also increased.