成人手术患者输血相关呼吸系统不良反应调查分析  

Research and analysis transfusion related respiratory adverse reactions in adult surgery patients

作　　者：王秋实[1] 杨巧妮[1] 林强[2] 

机构地区：[1]中国医科大学附属盛京医院输血科,110004 [2]中国医科大学附属盛京医院小儿急救医学编辑部,辽宁沈阳110004

出　　处：《中国输血杂志》2016年第12期1345-1349,共5页Chinese Journal of Blood Transfusion

摘　　要：目的探讨成人手术输血患者出现呼吸系统不良反应的原因及其诊断价值。方法收集本院2013年1月1日-2013年6月30日共1 977(人)份成人手术输血患者的电子病历(输血信息),调查并统计输血后<24 h出现的呼吸系统不良反应病例数,分析不良反应与输血相关程度,判断不良反应是否与输血相关。结果本组1 977名成人手术患者共输血2 343次、合计输注15 932 U,输注的各种血液制剂所占比例为滤除白细胞(简称滤白)红细胞悬液57.78%(8 022/15 932)、滤白灭活病毒冰冻血浆29.16%(5 069.5/15 932)、滤白冷沉淀9.06%(2 232/15932)、滤白机采血小板2.54%(396/15 932),其他121 U(1.46%);共发生与输血可能相关、很可能相关和肯定相关的呼吸系统不良反应(症状/体征)的次数占全部输血次数的2.82%(66/2 343),包括呼吸急促/心动过速16次(0.68%)、呼吸困难19次(0.81%)、血氧低18次(0.77%)、胸闷喘憋13次(0.55%)。经过诊断共发累计发生17次(0.72%)呼吸系统不良反应,包括输血相关性呼吸困难(TAD)10次、循环超负荷(TACO)2次、输血相关性急性肺损伤(TRALI)2、,严重过敏过敏反应1次。结论输血引起的手术患者呼吸系统不良反应值得临床高度重视,有必要建立完善的医院血液预警系统和培训系统。Objective To explore the respiratory adverse reaction and the diagnosis in adult surgery transfusion patients who received blood transfusion. Methods Collected 1977 adult surgery transfusion patients＇ information from electronic medical records in one hospital, the records were from January l, 2013 to June 30＇2013, collected the new appearing of re- spiratory adverse reactions in 24 h after blood transfusion, and analysis of the degree of adverse reactions, whether adverse re- actions associated with blood transfusion. Results A total of 2 343 times blood transfusion infom were collected in 1 977 a-duh surgery patients. Total 15 932 U blood components were infusion, including leukocyte depleted red blood cell 57.78% （022/15 932）, inactivated virus leukocyte depleted frozen plasma 29. 16% （5 069. 5/15 932 ）, leukocyte depleted cryoprecipitate 9. 06% （232/15 932）, leukocyte depleted platelet in 2. 54% （ 396/15 932） , other 121 U （ 1.46% ） .Total blood transfusions related, probably related respiratory adverse reac- tions were 2. 82% （66/2,343）, include shortness of breath / tachycardia ：16 times （0. 68%）, dyspnea： 19 （0. 81%）, low blood oxygen： 18 （ 0.77%）, chest wheezing suppress ： 13 （ 0. 55% ）. after diagnosis, total 17 respiratory adverse reac- tions, including blood transfusion correlation dyspnea （TAD） 10 times, over/oading circulation （TACO） 2 times, blood transfusion correlation of acute lung injury （TRALI） 2, and I severe allergic reactions.Conclusion Transfusion adverse re- actions of respiratory system in surgery in patients should been got more attention; it is necessary to establish haemovigilance and training system in the hospital.

关 键 词：输血不良反应 输血相关呼吸困难 循环超负荷 输血相关急性肺损伤 成人手术患者 呼吸系统 

分 类 号：R457.13[医药卫生—治疗学] R56[医药卫生—临床医学]