發(fā)布時(shí)間：2018-04-28 03:44

  本文選題：輸血不良反應(yīng) + 評(píng)估分級(jí)��； 參考：《中國(guó)輸血雜志》2017年04期

【摘要】：目的參考美國(guó)輸血不良反應(yīng)診斷標(biāo)準(zhǔn),對(duì)四川省20家三級(jí)醫(yī)院2014年部分上報(bào)輸血不良反應(yīng)進(jìn)行回顧性評(píng)估分級(jí),對(duì)輸血不良反應(yīng)分級(jí)評(píng)估方法進(jìn)行初步嘗試,希望為日后輸血不良反應(yīng)分類(lèi)分級(jí)評(píng)估標(biāo)準(zhǔn)的制定和輸血預(yù)警系統(tǒng)的建立提供借鑒。方法隨機(jī)抽取四川省19個(gè)地市20家三級(jí)醫(yī)院2014年上報(bào)輸血不良反應(yīng)166例,根據(jù)患者輸血前后生命體征的變化情況、臨床癥狀、相關(guān)實(shí)驗(yàn)室檢查等對(duì)輸血不良反應(yīng)進(jìn)行重新診斷評(píng)估,從"不良反應(yīng)類(lèi)型的肯定程度"、"反應(yīng)的嚴(yán)重程度"以及"反應(yīng)與輸血相關(guān)可能性的大小"3個(gè)方面進(jìn)行分級(jí)。結(jié)果1)從"反應(yīng)類(lèi)型的肯定程度"方面分析,98.14%(158例)的輸血不良反應(yīng)能夠根據(jù)患者臨床表現(xiàn)進(jìn)行較為準(zhǔn)確的類(lèi)型判斷;1.86%(3例)的輸血不良反應(yīng),患者未出現(xiàn)符合定義標(biāo)準(zhǔn)的明確臨床表現(xiàn),評(píng)估結(jié)果為"疑似"。2)從"反應(yīng)嚴(yán)重程度"方面分析,93.98%(156例)為輕中度輸血不良反應(yīng),可自行緩解或于臨床干預(yù)后迅速緩解;6.02%(10例)為重度輸血不良反應(yīng),臨床癥狀嚴(yán)重,雖然于對(duì)癥處理后緩解,但普遍缺少相關(guān)后續(xù)檢查和原因追蹤。3)從"反應(yīng)與輸血相關(guān)可能性的大小"方面分析,93.37%(155例)的不良反應(yīng)經(jīng)評(píng)估后"輸血相關(guān)性極高",患者癥狀肯定是由輸血原因?qū)е?6.63%(11例)的不良反應(yīng)則可能是由輸血以外的其它原因?qū)е碌?存在并非輸血不良反應(yīng)的可能性。結(jié)論輸血不良反應(yīng)的評(píng)估分級(jí)能夠增加輸血不良反應(yīng)判斷結(jié)果的準(zhǔn)確性和嚴(yán)謹(jǐn)性,有利于及時(shí)對(duì)患者進(jìn)行后續(xù)檢查和原因分析,避免輸血不良反應(yīng)錯(cuò)報(bào)漏報(bào),提高輸血安全,進(jìn)而為日后輸血不良反應(yīng)分類(lèi)分級(jí)標(biāo)準(zhǔn)的制定和輸血預(yù)警系統(tǒng)的建立奠定基礎(chǔ)。
[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.
【作者單位】： 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院輸血研究所;
【分類(lèi)號(hào)】：R457.1

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