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临床输血与检验

临床输血与检验 ›› 2025, Vol. 27 ›› Issue (6): 789-796.DOI: 10.3969/j.issn.1671-2587.2025.06.007

• 临床输血 • 上一篇    下一篇

输注新鲜冰冻血浆儿科脓毒血症患者的预后分析

段灵, 陈萍, 胡红兵   

  1. 华中科技大学同济医学院附属武汉儿童医院（武汉市妇幼保健院）输血科,湖北武汉 430000
  • 收稿日期:2025-04-25 出版日期:2025-12-20 发布日期:2025-12-24
  • 通讯作者: 胡红兵,主要从事临床输血、输血管理研究,E-mail：huhongbing@zgwhfe.com。
  • 作者简介:段灵,主要从事儿科临床输血、输血治疗研究,E-mail：duanling@zgwhfe.com。并列第一作者：陈萍,主要从事临床输血、疑难血型鉴定研究,E-mail：chenping@zgwhfe.com。

Prognostic Analysis of Fresh Frozen Plasma Transfusion in Pediatric Patients with Sepsis

DUAN Ling, CHEN Ping, HU Hongbing   

  1. Department of Blood Transfusion, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430000
  • Received:2025-04-25 Online:2025-12-20 Published:2025-12-24

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摘要： 目的 探讨新鲜冰冻血浆（fresh frozen plasma, FFP）在儿科脓毒血症患者中的临床应用及其与预后的关系。方法 通过对2023年1月—2024年12月在武汉儿童医院PICU住院的262例脓毒血症患儿进行回顾性分析,根据住院期间是否接受FFP输注将患儿分为输注组和非输注组,比较两组患儿在基本资料、实验室检查、临床干预及预后方面的差异。结果 输注组患儿（87例）在白细胞（P=0.007）、血小板（P=0.000）、凝血功能（P=0.000）等多项实验室指标、临床干预（P=0.000）及预后（P=0.000）上与非输注组（175例）存在显著差异。多因素二元logistic回归分析显示,FFP输注（HR 6.079,95%CI 1.336~27.661,P=0.020）、机械通气（HR 16.107,95%CI 4.637~55.949,P=0.000）以及PRISM Ⅲ评分≥15（HR 7.865,95%CI 1.539~40.208,P=0.013）是脓毒血症患儿住院死亡的独立预测因子;FFP输注（HR 3.242,95%CI 1.277~8.227,P=0.013）、乳酸脱氢酶（HR 1.001,95%CI 1.000~1.002,P=0.018）及PRISM Ⅲ评分≥15（HR 5.308,95%CI 1.420~19.840,P=0.013）是患儿发生多器官功能障碍综合征（MODS）的独立预测因子。除>10岁组患儿的死亡率外,输注组各年龄段患儿死亡率和MODS率都显著高于非输注组（P均<0.05）。FFP剂量>60 mL/kg、次数>3次、24 h内输注FFP组的患儿有最高的死亡率和MODS率。结论 FFP输注与儿科脓毒血症患者住院死亡及MODS的发生有显著相关性,提示临床医生应慎重考虑脓毒血症患者FFP的输注,以减少不合理使用。

关键词: 新鲜冰冻血浆, 脓毒血症, 儿科, 住院死亡率, 多器官功能障碍综合征

Abstract: Objective To investigate the clinical application of fresh frozen plasma (FFP) in pediatric patients with sepsis and its association with prognosis. Methods A retrospective analysis was conducted on 262 pediatric patients with sepsis admitted to the PICU of Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology between January 2023 and December 2024. Patients were categorized into an FFP transfusion group and a non-transfusion group based on whether they received FFP during hospitalization. Differences in characteristics, laboratory findings, clinical interventions, and prognostic outcomes between the two groups were compared. Results Significant differences were observed between the transfusion group (n=87) and the non-transfusion group (n=175) in laboratory parameters, including white blood cell count (P=0.007), platelet count (P=0.000), coagulation function (P=0.000), clinical interventions (P=0.000), and prognosis (P=0.000). Multivariate binary logistic regression analysis revealed that FFP transfusion (HR 6.079, 95%CI 1.336-27.661, P=0.020), mechanical ventilation (HR 16.107, 95%CI 4.637-55.949, P=0.000), and PRISM Ⅲ score≥15 (HR 7.865, 95%CI 1.539-40.208, P=0.013) were independent predictors of in-hospital mortality in pediatric patients with sepsis. Additionally, FFP transfusion (HR 3.242, 95%CI 1.277-8.227, P=0.013), lactate dehydrogenase levels (HR 1.001, 95%CI 1.000-1.002, P=0.018), and PRISM Ⅲ score≥15 (HR 5.308, 95%CI 1.420-19.840, P=0.013) were identified as independent predictors of multiple organ dysfunction syndrome (MODS). Except for children over 10 years old, the transfusion group exhibited significantly higher mortality and MODS rates across all age groups (all P<0.05). Notably, children receiving FFP doses>60 mL/kg, frequency>3 times, or FFP infusion within 24 hours demonstrated the highest mortality and MODS rates. Conclusion FFP transfusion is significantly associated with increased in-hospital mortality and MODS occurrence in pediatric patients with sepsis, suggesting that clinicians should evaluate the necessity of FFP administration to reduce its irrational use.

Key words: Fresh frozen plasma, Sepsis, Pediatrics, In-hospital mortality, Multiple organ dysfunction syndrome

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