特殊情况下紧急抢救输血病例的临床输血情况分析

Analysis of the blood transfusion of emergency rescue cases in clinical

目的以《特殊情况紧急抢救输血推荐方案》(简称《紧急输血方案》)指导临床在ABO同型血液储备无法满足需求时的紧急抢救输血实施。方法收集本院外科2014年1月-2015年12月临床手术用血>1 600 m L的相关病例164例,分为紧急抢救输血组(紧急输血组):ABO同型血液储备无法满足需求的患者紧急抢救输血病例7例;对照组:ABO同型血液储备满足需求的输血病例157例。分析并比较2组患者的ABO血型,术前交叉配血量/实际输血量值(C/T),凝血功能,输血后3 d、7 d的Hb以及直接抗球蛋白试验(直抗)和抗体筛查试验(抗筛)。结果紧急输血组与对照组分别为AB血型占85.7%(6/7)vs 5.7%(9/157)(P<0.01);紧急输血组与对照组中肝脏移植术患者术前APTT(s)为58.5±20.1 vs 29±13.4,TT(s)为27.3±8.1 vs 20.8±7.8(P<0.05)。AB型原位肝移植且术前凝血功能异常的患者易发生ABO同型血液储备无法满足需求的情况,输注O型红细胞后Hb可达到预期效果(P>0.05)。紧急输血组患者C/T值最低,临床备血严重不足。结论 ABO同型血液储备无法满足需求时致患者紧急抢救输血的发生由多种因素造成,《紧急输血方案》为临床紧急抢救输血提供了科学、切实可行的方法和操作程序。

Objective To analyze the blood transfusion when ABO-identical blood was insufficient for emergency rescue transfusion cases after Recommended programs of special emergency rescue transfusion was carried out,which was also referred to as Urgent blood transfusion,in order to guide safe and reasonable blood transfusion. Methods Surgical cases of blood transfusion involving more than 1600 ml in our hospital from Jan 2014 to Dec 2015（ n = 164） were collected,including a group of emergency rescue transfusion in which ABO-identical blood was insufficient（ n = 7）,and a control group in which ABO-identical blood was sufficient（ n = 157）. Patients＇ ABO type,C / T ratio,preoperative coagulation,Hb value in 2h,3d and 7d after blood transfusion were compared,while direct anti-globulin test or antibody screening test were retrospectively conducted. Results The proportion of AB type was 85. 7% in emergency rescue transfusion group,which was higher than the control group at 5. 7%（ P〈0. 05）. In the emergency rescue transfusion group,APTT（ s） and TT（ s） were 58. 5 ± 20. 1and 27. 3 ± 8. 1,respectively in the orthotopic liver transplantation cases,which were longer than the control group（ 29 ±13. 4 and 20. 8 ± 7. 8,respectively）（ P〈0. 05）. Emergency rescue transfusion were tended to be given to the patients of AB type and abnormal coagulation during orthotopic liver transplantation（ P〈0. 05）. The Hb values at different times showed no significant difference（ P〉0. 05）. The C / T ratio of the emergency rescue transfusion group was lowest,which indicated that the preparation of blood was severely insufficient. Conclusion Variety of factors contribute to emergency rescue transfusion cases in which ABO-identical blood was insufficient. Emergency rescue transfusion programs provides a scientific,practical and feasible method and operating procedures in times of insufficient blood reserves.