Vibede E, Hvas C L, Tønnesen E, Hvas A-M
Department of Clinical Biochemistry, Centre for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus N, Denmark.
Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark.
Acta Anaesthesiol Scand. 2017 May;61(5):492-501. doi: 10.1111/aas.12885.
Critically ill patients often receive fresh frozen plasma (FFP) if they have abnormal conventional coagulation tests. The aim of this study was to investigate the effect of FFP transfusion judged by a wide range of coagulation tests.
We included 30 critically ill patients receiving FFP and 30 critically ill patients who did not receive FFP. For patients receiving FFP, blood samples were obtained before and 1 h after FFP transfusion. Conventional coagulation tests, thromboelastometry (ROTEM , EXTEM, INTEM and FIBTEM) and thrombin generation were performed. Systematic recording of vital signs was performed for all patients.
The median values of the conventional coagulation tests were abnormal before and after FFP (PT: (normal > 0.6) median 0.3 before vs. 0.3 after; INR: (normal < 1.2) median 2 before vs. 1.7 after; APTT: (normal < 38 s) median 45 s before vs. 42 s after). Eight of nine ROTEM parameters were within the reference interval judged by median values before FFP transfusion, and all median parameters were within the reference interval after FFP transfusion. Median in three of four thrombin generation parameters was within the reference interval both before and after FFP transfusion.
Patients presented abnormal conventional coagulation tests both before and after FFP transfusion. In contrast, ROTEM and thrombin generation parameters were mainly within the reference interval both before and after FFP transfusion. FFP transfusions caused only negligible, although statically significant, improvements on coagulation measurements judged by conventional coagulation tests, ROTEM and thrombin generation.
危重症患者若常规凝血检查异常，常接受新鲜冰冻血浆（FFP）治疗。本研究旨在通过多种凝血检查评估FFP输注的效果。
我们纳入了30例接受FFP的危重症患者和30例未接受FFP的危重症患者。对于接受FFP的患者，在输注FFP前及输注后1小时采集血样。进行常规凝血检查、血栓弹力图（ROTEM、EXTEM、INTEM和FIBTEM）以及凝血酶生成检测。对所有患者进行生命体征的系统记录。
FFP输注前后常规凝血检查的中位数均异常（PT：（正常>0.6），输注前中位数为0.3，输注后为0.3；INR：（正常<1.2），输注前中位数为2，输注后为1.7；APTT：（正常<38秒），输注前中位数为45秒，输注后为42秒）。9项ROTEM参数中有8项在FFP输注前中位数判断的参考区间内，FFP输注后所有中位数参数均在参考区间内。4项凝血酶生成参数中有3项在FFP输注前后的中位数均在参考区间内。
FFP输注前后患者的常规凝血检查均异常。相比之下，ROTEM和凝血酶生成参数在FFP输注前后主要在参考区间内。FFP输注对常规凝血检查、ROTEM和凝血酶生成所判断的凝血指标仅产生了微小的改善，尽管具有统计学意义。
