儿科重症监护室成分输血应用情况分析

Analysis of application of blood component transfusion in pediatric intensive care unit

目的 分析儿科重症监护室（PICU）成分输血的应用特点,总结成分输血的经验,指导临床科学、合理用血。方法 对本院2011～2013年PICU成分输血资料进行回顾性分析。结果 1）PICU近3年收治患儿2 598例（危重组：2 111,极危重组：487）,成分输血732例,危重组输血率为22.7%（479/2 111）、极危重组输血率为52.0%（253/487）;治愈好转率输血组高于未输血组（P〈0.05）。2）用量占前3位的成分血分别是丙种球蛋白、血浆、人血白蛋白,分别占59.50%、11.76%、9.38%;成分输血应用率达100%。3）输血的病因前3位为重症感染、脏器功能衰竭、免疫性疾病,分别占39.15%、20.59%、13.33%,输血成分主要为丙种球蛋白、血浆、人血白蛋白;4）丙种球蛋白用量前3位病因分别为重症感染、脏器功能衰竭及免疫性疾病;血浆用量前3位病因分别为脏器功能衰竭合并凝血功能障碍、重症感染合并凝血功能障碍和原发性出凝血疾病;人血白蛋白用量前3位病因分别为重症感染（主要为重症脑炎）、脏器功能衰竭（严重低蛋白血症）和中毒意外。5）输血不良反应5例,发生率为0.70%,其中输红细胞发生不良反应2例,输血浆、丙种球蛋白、血小板输血不良反应各1例,主要表现为发热、过敏反应,经对症治疗均缓解,完成输注。结论 成分输血是儿科危重症治疗的重要手段,患儿危重程度越高,输血率越大,合理输血对改善PICU患儿的预后、提高抢救成功有着重要的地位。

Objective To analyze the characteristics of component transfusion in pediatric intensive care unit （ PICU）, to summarize the experience of component transfusion, and to guide the development of clinical science and the effective utilization of blood resources. Methods Blood component transfusion cases from 2011 to 2013 in PICU of our hospital were studied. Results 1 ） 2 598 children were admitted to PICU in nearly 3 years （ critical patients ：2 111 ;extremely critical patients ： 487）. 732 cases of blood component transfusion were conducted. The rate of blood transfusion in the critical group was 22. 7% （479/2 111 ） and that of the extremely critical group was 52.0% （253/487）. The rate of curability and improvement in the group with blood transfusion fared better than the group without transfusion （ P 〈 0. 05 ）. 2 ） The top three components transfused were gamma globulin serum, plasma and human serum albumin, accounting for 59.50%, 11.76% and 9.38%, respectively. The rate of application of blood component transfusion application approached 100%. 3 ） The top three causes of transfusion attributed to severe infection, organ failure and autoimmune diseases, accounting for 39.15% ,20.59% and 13. 33% ,respectively. The main components of the transfusion were gamma globulin, plasma and human serum albumin. 4）The top three causes to transfuse gamma globulin serum attributed to severe infection,organ failure and autoimmune diseases. The top three causes for plasma serum transfusion attributed to organ failure with coagulopathy,infection with severe coagulopathy and primary coagulation disorders. The top three causes for human serum albumin transfusion were severe infection （ primarily severe encephalitis） ,organ failure （severe hypoalbuminemia） and accident/poisoning. 5 ）There were five adverse transfusion reactions cases,including two cases of adverse reactions of red blood cells,and one case each for plasma transfusion,gamma globulin and platelet transfusion. These cases were predominantly fever and allergic reactions which were alleviated by symptomatic treatment and successful infusions. The rate of adverse transfusion reaction was 0.07%. Conclusion Blood component transfusion is an important means of pediatric critical care treatment. Gamma globulin and plasma are of significance to improve the successful rate of treatment in PICU. Rational use of blood transfusion and adequate storage of blood resources ensure effective treatment and emergency rescue efforts.