骨科创伤性失血患者输血不良反应调查及危险因素分析  

Investigation of adverse reactions and risk factors of blood transfusion in orthopedic patients with traumatic blood loss

作　　者：杨斌 夏克明 韩飞 YANG Bin;XIA Keming;HAN Fei(Department of Blood Transfusion,Beijing Jishuitan Hospital Guizhou Hospital,Guizhou Province,Guiyang550014,China)

机构地区：[1]北京积水潭医院贵州医院输血科,贵州贵阳550014

出　　处：《中国当代医药》2024年第10期131-134,共4页China Modern Medicine

摘　　要：目的调查骨科创伤性失血患者输血不良反应(ATR)情况并分析其影响因素。方法回顾性分析2019年6月至2023年6月期间北京积水潭医院贵州医院骨科病房接受输血治疗的1812例骨科创伤性失血患者的病历资料,统计ATR发生情况,收集其一般临床资料及可能的风险因素数据,采用logistic回归模型分析ATR的独立危险因素。结果1812例患者中,输注去白细胞悬浮红细胞1032例(56.95%)、悬浮红细胞620例(34.21%)、新鲜冰冻血浆98例(5.41%)、冷沉淀47例(2.59%)、血小板制剂15例(0.83%);共发生ATR 82例,其中发热非溶血性输血反应(FNHTR)49例,占比59.76%;过敏反应33例,占比40.24%,在不同的血液制剂中,新鲜冰冻血浆的ATR发生率最高,去白细胞悬浮红细胞的ATR发生率最低。单因素分析结果显示,ATR组与非ATR组年龄、性别、过敏史、输血次数、发血至输血时间、输血成分及输血前C反应蛋白(CRP)水平比较,差异有统计学意义(P<0.05)。多因素分析结果显示,有过敏史(β=1.127,OR=3.086,95%CI:2.260~4.215)、输血次数≥3次(β=0.892,OR=2.440,95%CI:1.728~3.445)、发血至输血时间≥30 min(β=0.673,OR=1.960,95%CI:1.348~2.850)、输血成分为新鲜冰冻血浆(β=1.315,OR=3.725,95%CI:2.454~5.655)、输血前CRP(β=1473,OR=4.362,95%CI:2.376~8.009)均为骨科创伤性失血输血患者发生ATR的独立危险因素(P<0.05)。结论骨科创伤性失血患者在输血过程中存在一定的ATR风险,且ATR的发生与过敏史、输血次数、发血至输血时间、输血成分及输血前CRP水平均独立相关,应针对这些风险因素进行早期识别和干预。Objective To investigate the occurrence of adverse transfusion reactions(ATR)in orthopedic traumatic hemorrhage patients and analyze its influencing factors.Methods The medical records of 1812 patients with orthopaedic traumatic blood loss who received blood transfusion treatment in the Orthopaedic Ward of Beijing Jishuitan Hospital Guizhou Hospital from June 2019 to June 2023 were retrospectively analyzed,the occurrence of ATR was statistically analyzed,and the general clinical data and possible risk factors were collected.The independent risk factors of ATR were analyzed by logistic regression model.Results Among the 1812 patients,1032(56.95%)received leukocyte-reduced red blood cells,620(34.21%)received red cells suspension,98(5.41%)received fresh frozen plasma,47(2.59%)received cryoprecipitate,and 15(0.83%)received platelet preparations.A total of 82 ATRs were reported,of which 49(59.76%)were febrile non-hemolytic transfusion reactions(FNHTR)and 33(40.24%)were allergic reactions.Among the different blood products,the ATR incidence was highest for fresh frozen plasma and lowest for leukocyte-reduced red blood cells.The results of the univariate analysis showed that there were statistically significant differences between the ATR group and the non-ATR group in terms of age,gender,history of allergies,number of transfusions,time from bleeding to transfusion,transfusion components,and pre-transfusion C-reactive protein(CRP)levels(P<0.05).The results of the multivariate analysis showed that history of allergies(β=1.127,OR=3.086,95%CI:2.260-4.215),receiving≥3 transfusions(β=0.892,OR=2.440,95%CI:1.728-3.445),time from bleeding to transfusion≥30 minutes(β=0.673,OR=1.960,95%CI:1.348-2.850),transfusion component being fresh frozen plasma(β=1.315,OR=3.725,95%CI:2.454-5.655)and pre-transfusion CRP(β=1473,OR=4.362,95%CI:2.376-8.009)were risk factors associated with the occurrence of ATR in orthopedic trauma patients with hemorrhagic transfusion(P<0.05).Conclusion Orthopedic traumatic hemorrhage patients have a ce

关 键 词：骨科 创伤性失血 输血不良反应 危险因素 

分 类 号：R457.13[医药卫生—治疗学]