大量输血对创伤患者炎症标志物、血清电解质、凝血功能及免疫功能的影响

The Impact of Massive Blood Transfusion on Inflammatory Markers, Serum Electrolytes, Coagulation Function, and Immune Function in Trauma Patients

摘要: 目的：本研究探讨大量输血(massive transfusion, MT)对创伤患者炎症标志物、血清电解质、凝血及免疫功能的影响。方法：研究纳入我院急诊科收治的136例创伤患者，分为MT组(41例)和一般输血组(对照组95例)。比较两组患者输血前后各指标变化情况，包括炎症标志物：白细胞介素-6 (IL-6)、白细胞介素-8 (IL-8)、粒细胞集落刺激因子(G-CSF)、单核细胞趋化蛋白-1 (MCP-1)、中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)；电解质：K⁺、Na⁺、Cl⁻、Ca²⁺和TCO₂；凝血指标：PT、APTT、TT、FIB和PLT；免疫指标：CD3⁺ T、CD4⁺ T和CD4⁺/CD8⁺。结果：输血后，MT组IL-6、IL-8和MCP-1显著高于对照组(P < 0.001)，NLR、PLR和G-CSF无显著变化(P > 0.05)。电解质方面，MT组K⁺、Ca²⁺和TCO₂浓度明显降低(P < 0.001)，Na⁺数值两组均升高且MT组更显著(P < 0.05)，Cl⁻水平无统计学差异(P > 0.05)。凝血功能上，MT组PLT、FIB数值降低，PT、APTT、TT时间延长(P < 0.001)。免疫功能方面，MT组CD3⁺ T、CD4⁺ T和CD4⁺/CD8⁺显著降低(P < 0.05)。结论：MT可能加重创伤患者炎症反应、电解质紊乱、凝血功能障碍及免疫功能抑制，需加强监测与干预。

Abstract: Objective: This study investigates the impact of massive transfusion (MT) on inflammatory markers, serum electrolytes, coagulation, and immune function in trauma patients. Methods: A total of 136 trauma patients admitted to the emergency department of our hospital were enrolled and divided into the MT group (41 cases) and the general transfusion group (control group, 95 cases). The changes in various indicators before and after transfusion were compared between the two groups, including inflammatory markers: interleukin-6 (IL-6), interleukin-8 (IL-8), granulocyte colony-stimulating factor (G-CSF), monocyte chemoattractant protein-1 (MCP-1), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR); electrolytes: K⁺, Na⁺, Cl⁻, Ca²⁺, and TCO₂; coagulation parameters: PT, APTT, TT, FIB, and PLT; and immune parameters: CD3⁺ T, CD4⁺ T, and CD4⁺/CD8⁺. Results: After transfusion, the MT group showed significantly higher levels of IL-6, IL-8, and MCP-1 compared to the control group (P < 0.001), while NLR, PLR, and G-CSF showed no significant changes (P > 0.05). In terms of electrolytes, the MT group exhibited significantly lower concentrations of K⁺, Ca²⁺, and TCO₂ (P < 0.001), while Na⁺ levels increased in both groups, with a more pronounced increase in the MT group (P < 0.05). Cl⁻ levels showed no statistically significant difference (P > 0.05). Regarding coagulation function, the MT group had reduced PLT and FIB levels, and prolonged PT, APTT, and TT times (P < 0.001). In terms of immune function, the MT group showed significant reductions in CD3⁺ T, CD4⁺ T, and CD4⁺/CD8⁺ ratios (P < 0.05). Conclusion: MT may exacerbate inflammatory responses, electrolyte imbalances, coagulation dysfunction, and immune suppression in trauma patients, necessitating enhanced monitoring and intervention.