输血治疗临床应用.ppt

* 大量出血的输液输血疗法 第一阶段 输液疗法 恢复血管容量 第二阶段 输血疗法 恢复组织供氧 第三阶段 血液成分的补充 纠正凝血障碍 * 大量输血时血液成分的选择和使用原则 最好输注全血* 输注血小板 A dilutional effect on the platelet concentration can be seen with massive transfusion. In an adult, each 10 to 12 units of transfused red cells can produce a 50 percent fall in the platelet count; thus, significant thrombocytopenia can be seen after 10 to 20 units of blood, with platelet counts below 50,000/μL. PT和APTT延长1.5倍时，输注FFP 剂量： 10～15ml/kg 纤维蛋白原1000mg/L输注冷沉淀 剂量：6-unit pool for fibrinogen levels between 500-1000 mg/L; 12-unit pool for fibrinogen levels 500mg/L. * Warm fresh whole blood transfusion for severe hemorrhage: U.S. military and potential civilian applications.Spinella PC.Crit Care Med. 2008 Jul;36(7 Suppl):S340-5 Between March 2003 and July 2007, over 6000 units of warm fresh whole blood have been transfused in Afghanistan and Iraq by U.S. medical providers to patients with life-threatening traumatic injuries with hemorrhage. Preliminary results in approximately 500 patients with massive transfusion indicate that the amount of fresh warm whole blood transfused is independently associated with improved 48-hr and 30-day survival and the amount of stored red blood cells is independently associated with decreased 48-hr and 30-day survival for patients with traumatic injuries that require massive transfusion. Risks of warm fresh whole blood transfusion include the transmission of infectious agents. * CONCLUSIONS For patients with life-threatening hemorrhage at risk for massive transfusion, if complete component therapy is not available or not adequately correcting coagulopathy, the risk:benefit ratio of warm fresh whole blood transfusion favors its use. In addition, recent evidence suggests that there is potential for warm fresh whole blood to be more efficacious than stored component therapy that includes stored red blood cells in critically ill patients requiring massive transfusion. * Harke研究表明输注全血的患者凝血功能筛选试验基本都是正常的；