166例输血不良反应的回顾性评估分级研究

发布时间：2018-04-28 03:44

本文选题：输血不良反应 + 评估分级　；参考：《中国输血杂志》2017年04期

【摘要】：目的参考美国输血不良反应诊断标准,对四川省20家三级医院2014年部分上报输血不良反应进行回顾性评估分级,对输血不良反应分级评估方法进行初步尝试,希望为日后输血不良反应分类分级评估标准的制定和输血预警系统的建立提供借鉴。方法随机抽取四川省19个地市20家三级医院2014年上报输血不良反应166例,根据患者输血前后生命体征的变化情况、临床症状、相关实验室检查等对输血不良反应进行重新诊断评估,从"不良反应类型的肯定程度"、"反应的严重程度"以及"反应与输血相关可能性的大小"3个方面进行分级。结果1)从"反应类型的肯定程度"方面分析,98.14%(158例)的输血不良反应能够根据患者临床表现进行较为准确的类型判断;1.86%(3例)的输血不良反应,患者未出现符合定义标准的明确临床表现,评估结果为"疑似"。2)从"反应严重程度"方面分析,93.98%(156例)为轻中度输血不良反应,可自行缓解或于临床干预后迅速缓解;6.02%(10例)为重度输血不良反应,临床症状严重,虽然于对症处理后缓解,但普遍缺少相关后续检查和原因追踪。3)从"反应与输血相关可能性的大小"方面分析,93.37%(155例)的不良反应经评估后"输血相关性极高",患者症状肯定是由输血原因导致;6.63%(11例)的不良反应则可能是由输血以外的其它原因导致的,存在并非输血不良反应的可能性。结论输血不良反应的评估分级能够增加输血不良反应判断结果的准确性和严谨性,有利于及时对患者进行后续检查和原因分析,避免输血不良反应错报漏报,提高输血安全,进而为日后输血不良反应分类分级标准的制定和输血预警系统的建立奠定基础。
[Abstract]:Objective referring to the diagnostic criteria of adverse reaction of blood transfusion in the United States, the adverse reactions of transfusion in 20 hospitals in Sichuan province in 2014 were evaluated retrospectively, and the methods of classification evaluation of adverse reactions of blood transfusion were preliminarily tried. It is hoped to provide reference for the establishment of classification and grading criteria for blood transfusion adverse reactions and the establishment of blood transfusion warning system. Methods 166 cases of adverse reactions of blood transfusion were randomly selected from 20 tertiary hospitals in 19 prefectures and cities of Sichuan province in 2014. According to the changes of vital signs before and after transfusion, the clinical symptoms were analyzed. The related laboratory tests were used to re-diagnose and evaluate the adverse reactions of blood transfusion, which were classified into three aspects: "the positive degree of adverse reaction type", "severity of reaction" and "the possibility of reaction and transfusion related". Results 1) from the point of view of "positive degree of reaction type", the adverse reactions of blood transfusion in 158 cases (98.14%) could be judged according to the clinical manifestations of the patients by a more accurate classification of 1.86% of the blood transfusion adverse reactions. There was no definite clinical manifestation according to the defined criteria. The result of evaluation was "suspected". (2) 156 cases of "severity of reaction" were analyzed as mild and moderate adverse reactions of blood transfusion. 10 cases of severe adverse reactions of blood transfusion were relieved by self-relief or rapid relief after clinical intervention. The clinical symptoms were severe, although they were relieved after symptomatic treatment. But there is a general lack of follow-up examination and cause tracing. 3) Analysis of the adverse reactions from the perspective of "the likelihood of reaction and blood transfusion" (155 cases) the adverse reactions were assessed as "extremely relevant to blood transfusion", and the cause of the patient's symptoms must have been caused by blood transfusion. In 11 cases, the adverse reactions may be caused by something other than blood transfusions. There is the possibility that there is no adverse reaction to blood transfusion. Conclusion the evaluation and grading of adverse reactions of blood transfusion can increase the accuracy and rigour of the results of adverse reactions of blood transfusion, which is helpful to carry out follow-up examination and cause analysis in time, to avoid misreporting of adverse reactions of blood transfusion, and to improve the safety of blood transfusion. It will lay a foundation for the establishment of classification and classification standard of adverse reactions of blood transfusion and the establishment of early warning system for blood transfusion.
【作者单位】：中国医学科学院北京协和医学院输血研究所;
【分类号】：R457.1

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