大面积烧伤患者反复输血输液抗感染治疗对输血血清学的影响  

The Influencing of Multiple Transfusions and Antibiotic Administrations on Cross Matching of Blood in Patients with Extensive Burns

作　　者：张秋会[1] 孙文利[1] 安群星[1] 张婧[1] 尹文[1] ZHANG Qiu-hui;SUN Wen-Li;AN Qun-Xing(Department of Blood Transfusion,XijingHospital,The Fourth Military Medical University,Xi＇an 710032)

机构地区：[1]陕西省西安市第四军医大学西京医院输血科,710032

出　　处：《临床输血与检验》2018年第6期585-587,共3页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的回顾性探讨与分析大面积烧伤患者多次输血输液抗感染治疗对交叉配血的影响,并制订适宜的检测策略和交叉配血方案。方法选取本院烧伤科住院的大面积烧伤患者(烧伤面积大于85%以上)111例,入院后经大量输血输液抗感染治疗,当患者再次需要输血做交叉配血时,主次侧出现交叉配血不合现象。为此,应用吸收放散技术对大面积烧伤患者的红细胞和血清进行检测,并且利用谱细胞来鉴定抗体特异性。结果 111例大面积烧伤患者中,共检出同种抗体48例,占43.2%,红细胞直接抗人球蛋白试验阳性占23.4%(26/111),蛋白异常凝集占20.7%(23/111),药物性抗体占12.6%(14/111)。结论长期大量输注头抱类抗生素,反复多次输注悬浮红细胞、去白红细胞悬液、白蛋白、冰冻血浆和冷沉淀后,会导致机体产生免疫反应,使患者体内产生血型同种抗体、药物性抗体、自身抗体及红细胞被致敏等,这些现象是影响大面积烧伤患者交叉配血不合的主要因素。Objective To retrospectively discuss and analyze the influencing factors of multiple transfusions oncross transfusion in the patients with extensive burns in order to formulate an appropriate detection and blood cross matchingstrategy. Methods One hundred and eleven patients with large area （more than 85% ） burn were collected in the surgerydepartment. Among the patients who had received transfusion and anti-infection treatments,the cross matching incompatibilitywas seen on the primary and secondary sides. Therefor the red blood cells and alloantibodies of patients were detected withabsorption and elution technique. Results Forty eight of 111 （43.2%） patients were found to have alloantibodies,26 ofthem （23.4%） had erythrocyte direct antihuman globulin antibodies,23 of them （20.7%） presented positive abnormalprotein aggregation,and 14 of them（12.6%） showed positive antibodies against medicine used. Conclusions A long termuse of antibiotics,frequent transfusions of red blood cell suspension and leukocyte poor red blood cells,albumin,frozenplasma,and cryoprecipitate will result in alloantibodies,drug antibodies,autoantibodies,and erythrocyte sensitization,constituting the factors influencing blood cross matching incompatibility.

关 键 词：大面烧伤患者 多次输血 抗感染 治疗 交叉配血不合 

分 类 号：R556.62[医药卫生—血液循环系统疾病] R457.1[医药卫生—内科学]