發(fā)布時間：2018-04-28 03:44

  本文選題：輸血不良反應 + 評估分級　； 參考：《中國輸血雜志》2017年04期

【摘要】：目的參考美國輸血不良反應診斷標準,對四川省20家三級醫(yī)院2014年部分上報輸血不良反應進行回顧性評估分級,對輸血不良反應分級評估方法進行初步嘗試,希望為日后輸血不良反應分類分級評估標準的制定和輸血預警系統的建立提供借鑒。方法隨機抽取四川省19個地市20家三級醫(yī)院2014年上報輸血不良反應166例,根據患者輸血前后生命體征的變化情況、臨床癥狀、相關實驗室檢查等對輸血不良反應進行重新診斷評估,從"不良反應類型的肯定程度"、"反應的嚴重程度"以及"反應與輸血相關可能性的大小"3個方面進行分級。結果1)從"反應類型的肯定程度"方面分析,98.14%(158例)的輸血不良反應能夠根據患者臨床表現進行較為準確的類型判斷;1.86%(3例)的輸血不良反應,患者未出現符合定義標準的明確臨床表現,評估結果為"疑似"。2)從"反應嚴重程度"方面分析,93.98%(156例)為輕中度輸血不良反應,可自行緩解或于臨床干預后迅速緩解;6.02%(10例)為重度輸血不良反應,臨床癥狀嚴重,雖然于對癥處理后緩解,但普遍缺少相關后續(xù)檢查和原因追蹤。3)從"反應與輸血相關可能性的大小"方面分析,93.37%(155例)的不良反應經評估后"輸血相關性極高",患者癥狀肯定是由輸血原因導致;6.63%(11例)的不良反應則可能是由輸血以外的其它原因導致的,存在并非輸血不良反應的可能性。結論輸血不良反應的評估分級能夠增加輸血不良反應判斷結果的準確性和嚴謹性,有利于及時對患者進行后續(xù)檢查和原因分析,避免輸血不良反應錯報漏報,提高輸血安全,進而為日后輸血不良反應分類分級標準的制定和輸血預警系統的建立奠定基礎。
[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】： 中國醫(yī)學科學院北京協和醫(yī)學院輸血研究所;
【分類號】：R457.1

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