一家三甲医院近7年输血不良反应的发生情况及原因分析  

Causal analysis and distribution of transfusion adverse reaction in a tertiary hospital for seven years

作　　者：王向明[1] 柏灵灵[2] 王珏[1] 尹湧华[1] 王旭 宋宁[1] 田力 康凯[2] 练正秋[2] 刘忠[1] 

机构地区：[1]中国医学科学院北京协和医学院输血研究所,四川成都610052 [2]成都市第三人民医院输血科 [3]川北医学院医学检验系

出　　处：《中国输血杂志》2017年第4期375-378,共4页Chinese Journal of Blood Transfusion

基　　金：中国医学科学院医学与健康科技创新工程(2016-I2M-3-024);北京协和医学院2016年度校级研究生教育教学改革项目(10023201601901)

摘　　要：目的全面了解该院7年来输血不良反应的发生情况,并分析其分布特点和可能的相关性因素,为深入研究输血不良反应的发生机制提供参考。方法通过手工查阅2010年以来所有输血不良反应的相关记录信息,通过电子病历的输血管理系统查阅2013年来所有悬浮红细胞的有效期和发血日期。结果 2010年以来,从该院输血不良反应发生率来看,总体发生率为2.38±0.86‰(349次/151 605 U),血小板为5.64‰,红细胞为3.17‰,血浆为1.28‰,冷沉淀为0.94‰。在非溶血性发热反应中RBC占64%(172/212);过敏反应中血浆占38.1%(40/105),血小板占28.6%(30/105)。消化内科和血液内科分别占输血反应总数的32%和21%(110/349和72/349);消化道出血患者发生的不良反应中RBC占93%(63/68);肝病患者发生的不良反应中血浆占71%(17/24);白血病患者发生的不良反应中血小板占57%(20/35)。储存期为第1、2、3和第4周的悬浮RBC不良反应发生率分别为5.66‰、4.49‰、3.65‰和4.89‰。结论 RBC发生的输血不良反应以非溶血性发热为主,其他血液成分以过敏反应为主;随着悬浮RBC储存时间的延长,其输血不良反应的发生率出现先降低后升高的趋势。本研究不能完全排除疾病类型和相关血液成分之间发生特定输血不良反应的相关性。Objective To explore the possible mechanism of transfusion adverse reaction （TAR）, to comprehend the overall status of TAR, and to analyze the characteristics of distribution and correlative factors of TAR from the data collected in seven years in a tertiary hospital. Methods All the TAR records since 2010 collected manually were analyzed, from which, the storage periods of all the suspended red blood cells （RBC） were calculated. Results Since 2010, the overall incidence of the hospital blood transfusion reactions was 2. 38 ＋/-0. 86 %o （n=349/151 605 u） , 5.64 %o for platelets, 3. 17 ‰ for RBC, 1.28 ‰ for plasma and 0. 94 %o for cold precipitation. 64% of non hemolytic febrile reaction lied in RBC （ 172/ 212）, while 38.1% and 28.6% of allergic reaction were caused by plasma （40/105 ） and platelets （30/105 ）. The amounts of TARs in departments of Gastroenterology and Hematological accounted for 32% and 21%, respectively （ 110/349 and 72/ 349）. 93% of TARs in patients with gastrointestinal bleeding were caused by RBC （63/68） ; 71% in patients with liver disease lied in plasma （17/24） ; 57% TARs of patients in the leukemia were caused by platelets （20/35）. The incidences of TARs of shelf life of 1, 2, 3 and 4 weeks of suspended RBC were 5.66‰, 4.49 ‰, 3.65 ‰ and 4. 89 ‰. Conclusion Among all the TARs, RBC is given priority in NHFRs, other blood components are given priority in allergic reactions. Among various types of blood components, the highest frequency of TARs lies in PLT. As the duration of suspended RBC lengthens, the incidence of TAR of suspended RBC stored periods declines at the beginning and increases near the shelf time. This study cannot completely rule out the correlation between specific TAR and certain types of disease.

关 键 词：输血不良反应 消化道出血 红细胞 储存损伤 临床输血 

分 类 号：R457.1[医药卫生—治疗学]