输血不良反应的持续改进与分析

Improvement and analysis of transfusion adverse reactions

目的:研究患者在输血发生发热性非溶血性输血反应(FNHTR)的相关危险因素及防控对策。方法:选取2015—2016年输血12 446人次中发生FNHTR的输血患者21例,分析相关危险因素,抽取发生疑似细菌性输血反应的8例患者及其对应的供者血液标本进行血培养并采用软件统计学分析。结果:FNHTR发生率0.17%(21/12 446),其中女性、有输血史、受血者年龄>60岁、输注悬浮红细胞、使用的血液失效期≤5d时,FNHTR的发生率上升明显;3例发生疑似细菌性输血反应患者血培养标本阳性率33.3%(1/3),其中,2015年1例受血者血培养阳性,鉴定结果为大肠埃希菌,其他2例标本培养结果均为阴性。结论:FNHTR的发生与受血者年龄、性别、输血史、妊娠史、血液有效期、输注的血液成分有关,血站和医院应加强血液管理和科学合理用血监管力度,采取持续改进措施降低FNHTR的发生率;一旦发生FNHTR,需按照相关输血流程进行调查分析,及时救治。

Objective：To investigate the risk factors and prevention and control countermeasures of febrile nonhemolytic transfusion reactions（FNHTR）in patients with blood transfusion.Method：Twenty-one cases of FNHTR transfused patients were selected from 12 446 transfusions in 2015-2016.The related risk factors were analyzed.Eight patients with suspected bacterial transfusion reactions and their corresponding donor blood samples were collected for blood culture and software was used.Statistical analysis.Result：The incidence of FNHTR was0.17%（21/12 446）.Incidence of FNHTR was increased in females,with history of blood transfusions,age of recipients〉60 years,infusion of suspended red blood cells,and blood-expiration period of≤5 days.Obviously,the positive rate of blood culture specimens in 3 patients with suspected bacterial transfusion reactions was 33.3%（1/3）,of which,in 1 year,blood cultures of 1 recipient were positive,the identification result was E.coli,and the other2 specimens were cultured.The results were negative.Conclusion：The occurrence of FNHTR is related to age,sex,blood transfusion history,pregnancy history,blood expiration date,and blood components of blood transfusion.Blood stations and hospitals should strengthen blood management and scientific and rational use of blood supervision,and take continuous improvement measures to reduce the incidence of FNHTR;once FNHTR occurs,the investigation and analysis should be conducted in accordance with the relevant blood transfusion procedures and timely treatment.