红细胞输注的疗效观察与输注无效的探讨

Observation of red blood cell transfusion efficiency and analysis of unsuccessful transfusion

目的观察患者输注红细胞的疗效,分析红细胞输注无效的影响因素并探讨相应的对策。方法用回顾性分析的方法对2015年1月-3月的359例红细胞输注患者的输血资料、临床病志及检验结果进行统计和结果分析。结果 359例去白细胞悬浮红细胞输注患者共输血756次,其中输注无效有138次,输注无效率为18.2%(138/756)。既往输量<10 U、输血次数>3次和有妊娠史的患者红细胞输注无效的发生率分别为24.3%(37/152),64.2%(61/95),17.1%(58/340)比其他患者高;血液病和恶性肿瘤患者红细胞输注无效的发生率为26.4%(33/125)和37.1%(43/116)比其他疾病的患者高;年龄大的患者输血无效率32.3%(30/93)比年轻患者的13.0%(31/239)高;次侧配血阳性者比阴性者更容易发生输注无效,前者是31.1%(47/151)后者是15.0%(91/605)。结论患者的疾病种类、既往输血史、输血次数、年龄、妊娠史及次侧交叉配血结果对输血效果的影响较为显著。临床医生应该根据患者的具体情况把握好输血指证和输血量,制定合理有效的输血策略,尽量减少输血次数,避免发生红细胞输注无效。

Objective To analyze the factors for unsuccessful red blood cell transfusion and to explore corresponding strategies by investigating the clinical efficiency of red blood cell transfusion. Methods A statistical and retrospective analy- sis was conducted on data regarding transfusion, course of clinical disease and test results in 359 patients transfused with red blood cells from January to March 2015 in The First Affiliated Hospital of Dalian Medical University. Results Among the 359 patients with 756 times of infusion with red blood cell suspension, there were 138 unsuccessful transfusion cases. The frequency of unsuccessful RBC transfusion was 18.2%. The frequencies of unsuccessful transfusions in patients with more than 10U amount of donation, more than 3 times of transfusion in the past and pregnancy history were 24. 3% （37/152）, 64. 2% （61/95） , 17.1% （58/340） , respectively, which were higher than other cases. The frequencies of unsuccessful transfusions in patients with tumor and hematopathy were 26.4% （33/125） and 37.1% （43/116）, respectively, which were higher than others. Unsuccessful transfusions were more likely to occur in older patients at 32. 3% （30/93） than young people at 13.0% （31/239）. Minor crossmatches were more likely to cause unsuccessful transfusions at a rate of 31.1% （47/151） than major crossmatches at 15.0% （91/605）. Conclusion The effectiveness of RBC transfusion is profonndly associated with the kind of disease in patients, numbers of previous transfusions, past record of pregnancy and the results of minor crossmatches. Clinicians should establish a rational and effective strategy according to the diverse needs of patients. They should also try to reduce the number of transfusion in order to avoid unsuccessful rates of RBC transfusion.