胃癌术后输血相关急性肺损伤处置与分析  

Management and analysis of transfusion related acute lung injury after gastric cancer surgery

作　　者：宋雪珍 薄金双 王甜甜[1] 宋雪梅 SONG Xuezhen;BO Jinshuang;WANG Tiantian;SONG Xuemei(Department of Blood Transfusion,Weihai Municipal Hospital Affiliated to Shandong University,Weihai,Shandong 264200,China;Weihai Blood Center,Weihai,Shandong 264200,China)

机构地区：[1]山东大学附属威海市立医院输血科,山东威海264200 [2]威海市中心血站,山东威海264200

出　　处：《国际检验医学杂志》2024年第S01期112-116,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨输血相关急性肺损伤的临床表现、诊断和治疗,为临床及时诊治提供参考。方法回顾性分析胃癌术后输血相关急性肺损伤患者的病例资料,影像检查、检验结果及临床表现。结果该患者胃癌术后,在输注病毒灭活冰冻血浆1 h内出现发热、寒战、低氧血症、急性肺水肿等临床表现。临床立即停止输血,给予高流量吸氧和气管插管呼吸末正压辅助通气,生命体征逐步平稳。患者术后白细胞总数(WBC)由4.66×10^(9)/L升高至12.73×10^(9)/L,中性粒细胞总数(Neu)由2.72×10^(9)/L升高至11.2×10^(9)/L,C反应蛋白(CRP)由2.59 mg/L升高至16.57 mg/L。输血不良反应发生后,WBC和 Neu均下降,而 CRP持续升高。B型钠尿 肽前体(NT-proBNP)正常,但病情加重时显著升高至1717.38 pg/mL,随病情好转逐渐减低至正常值。结论 对术后因输血引起的进展性低氧血症、呼吸窘迫的患者,临床医师要及早识别,明确诊断和治疗方案,提高患者 抢救成功率。Objective To investigate the clinical presentation,diagnosis and treatment of transfusion-related acute lung injury(TRALI).It will provide a reference for clinicians to promptly identify and cure cases of TRALI.Methods Clinical data from a patient with TRALI were retrospectively analyzed.Results The patient experienced fever with chills,hypoxemia and acute pulmonary edema within 1 h of virus inactivated frozen plasma transfusion following gastric cancer surgery.The plasma transfusion was terminated immediately.The patient was given positive high flow oxygen and pressure ventilation via an endotracheal tube.The patient's condition gradually improved.Postoperative white blood cell count(WBC),neutrophils(Neu)and Creactive protein(CRP)of the patient were elevated to 12.73×10^(9)/L,11.2×10^(9)/L and 16.57 mg/L,respectively.WBC and Neu decreased,while CRP showed continuous increase following adverse effects after plasma transfusion.B-type natriuretic peptide(NT-proBNP)was at a normal level in the event of adverse reactions,but it significantly elevated to 1717.38 pg/ml at the time of exacerbation,which was decreased to normal values when the patient condition improved gradually.Conclusion For postoperative patients with progressive hypoxemia and respiratory distress after blood transfusion,it is important to identify and treat TRALI as early as possible to improve the success rate of rescue.

关 键 词：输血 急性肺损伤 输血不良反应 

分 类 号：R656.61[医药卫生—外科学] R735.2[医药卫生—临床医学]