心脏手术后输血相关急性肺损伤11例

Report of eleven cases on transfusion related acute lung injury after cardiac surgery

目的 总结心脏手术后输血相关性急性肺损伤（transfusion related acute lung injury,TRALI）的预防原则治疗方法,探讨误诊及治疗失误原因,以期改进疗效.方法 总结分析2004年1月至2013年5月接受心脏手术后出现气管内大量浆液性分泌物伴顽固低氧血症病例资料和治疗方法.结果 11例患者具有典型TRALI临床表现,手术室内发病4例,监护室内发病7例.输入血浆诱发5例,输入库存红细胞诱发6例,发病距输入血液制品时间为（2.1±1.8）h.全部患者需要呼吸机辅助通气治疗,死亡6例.结论 心脏手术后TRALI容易误诊,病死率高.熟悉TRALI疾病特点,掌握诊断标准早期诊断、合理治疗可降低病死率.

Objective To review and analyze clinical features and outcomes of transfusion related acute lung injury （TRALI） in patients underwent cardiac surgery,investigate the reasons of misdiagnosis and inappropriate treatment,summarize prevention and treatment strategies for achieving better results.Methods The medical records of 11 cases patients who underwent cardiac surgery in our hospital from January,2004 to May,2013 with special features of a profuse amount of serosanguinous fluid originating from endotracheal tube and hypoxemia were reviewed.Results 11 cases fulfilled the diagnosis criteria of TRALI.There were 4 cases with the acute onset of symptoms at operating room and 7 cases in ICU.TRALI were induced by plasma transfusion in 5 cases and by bank red blood cell transfusion in 6 cases.The time duration from blood transfusion to symptoms onset were（2.1 ± 1.8） hours.All patients needed mechanical ventilation to improve symptoms.Six patients died within hospital,the mortality rate was 54.1%.Conclusion TRALI after cardiac surgery are associated with high mortality and misdiagnosis rates.Understanding the diagnoses criteria,providing early and appropriate treatments may lower the mortality rates.