Clinical study on coagulation function and immune function in patients undergoing ECMO treatment after blood transfusion
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摘要: 目的 探讨输血治疗对体外膜肺氧合(extracorporeal membrane oxygenation，ECMO)患者凝血功能及免疫功能的影响。方法 选取医院2020年2月—2022年2月进行过ECMO治疗和输血治疗的患者56例，比较输血前后患者电解质、凝血功能、体液免疫和细胞免疫等各项指标的变化。结果 ECMO患者输血后血K+、血Na+水平均有所降低，且血K+水平差异有统计学意义(P＜0.05)；血Ca2+水平无显著变化(P>0.05)；凝血相关检测指标中活化部分凝血活酶时间、凝血酶原时间、凝血酶时间均升高，而纤维蛋白原有所降低，且差异均有统计学意义(P＜0.05)；血小板计数下降, 差异有统计学意义；血清免疫球蛋白IgA、IgG、IgM水平、NK细胞计数、CD4+含量、CD4+/CD8+比值均降低，CD8+含量升高，差异均有统计学意义(P＜0.05)。结论 ECMO患者输血后会出现电解质、凝血功能以及免疫功能指标异常，临床中应高度重视ECMO患者血液管理，减少异体血液的输注及输血不良反应，提高输血疗效，保障患者安全。Abstract: Objective To investigate the effects of blood transfusion therapy on coagulation and immune function in patients undergoing extracorporeal membrane oxygenation(ECMO) therapy.Methods 56 patients who underwent ECMO treatment and blood transfusion treatment in our hospital from February 2020 to February 2022 were selected The changes of electrolyte, coagulation function, humoral immunity and cellular immunity in patients before and after blood transfusion were compared statistically.Results After blood transfusion treatment, the levels of K+ and Na+ in ECMO patients decreased compared to before transfusion, and there was a statistically significant difference in K+ levels after transfusion(P<0.05), while there was no significant change in blood Ca2+ levels, The activated partial thromboplastin time, prothrombin time and thrombin time increased, while the platelet count and fibrinogen concentration decreased, and the difference was statistically significant(P<0.05). After blood transfusion, the serum immunoglobulin IgA, IgG, IgM levels, NK cell count, CD4+ content, and CD4+/CD8+ ratio of patients decreased, while the CD8+ content increased, with statistical significance(P<0.05).Conclusion After blood transfusion, ECMO patients may experience abnormalities in electrolytes, coagulation function, and immune function indicators. In clinical practice, high attention should be paid to the management of blood transfusion in ECMO patients, reducing the transfusion of allogeneic blood and adverse reactions, improving the efficacy of blood transfusion, and ensuring patient safety.
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表 1 输血前后血清电解质水平比较
mmol/L，X±S 时间 K+ Na+ Ca2+ 输血前 4.42±0.25 144.12±10.21 1.98±0.23 输血后 3.88±0.20 133.23±7.29 1.90±0.30 t 7.694 1.567 0.251 P ＜0.001 0.119 0.802 
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表 2 凝血功能及PLT指标比较
X±S 时间 PT/s APTT/s TT/s FIB/(g/L) PLT/(109/L) 输血前 14.28±2.67 33.78±4.26 17.89±4.34 3.67±0.88 189.32±50.12 输血后 28.89±3.17 55.18±7.26 23.72±4.02 2.09±0.74 68.01±43.13 t 24.252 19.251 8.826 7.244 11.604 P ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
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表 3 体液免疫功能比较
g/L，X±S 时间 IgG IgA IgM 输血前 11.23±1.45 4.88±0.79 1.13±0.16 输血后 6.58±1.46 3.29±0.74 0.82±0.09 t 5.714 8.032 11.837 P ＜0.001 ＜0.001 ＜0.001
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表 4 细胞免疫指标比较
X±S 时间 NK/% CD4+/% CD8+/% CD4+/CD8+ 输血前 19.46±2.12 45.89±7.33 24.05±3.43 1.80±0.23 输血后 14.32±2.86 35.19±2.13 30.17±1.67 1.38±0.20 t 2.295 15.138 10.260 8.543 P 0.023 ＜0.001 ＜0.001 ＜0.001
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