输血相关急性肺损伤的危险因素及预后分析

Analysis of the Risk Factors and Prognosis in Transfusion-related Acute Lung Injury

目的分析输血后发生输血相关急性肺损伤(transfusion-related acute lung injury,TRALI)的相关危险因素,并探讨TRALI对预后的影响。方法回顾2008年12月～2016年12月,以37例TRALI患者为观察组,随机抽取无TRALI发生患者58例为对照组,对比两组患者的性别、年龄及临床指标,分析可能影响TRALI发生的危险因素。结果观察组患者的HLA抗体Ⅱ、围术期输血量、总输液量、输血前休克、吸烟史、机械通气、肝脏疾病发生率均高于对照组,差异有统计学意义(P<0.05)。Logistic回归分析显示HLA抗体Ⅱ、围术期输血量、输血前休克、吸烟史、肝脏疾病为TRALI发生的独立危险因素。经Log-rank检验,两组间生存率比较差异有统计学意义(χ~2=49.056,P<0.05),经Kaplan-Meier法绘制生存曲线可看出,观察组生存率较低,而对照组的生存率较高。结论输血后发生TRALI的原因与患者HLA抗体Ⅱ、围术期输血量、输血前休克、吸烟史、肝脏疾病有关,发生TRALI的患者预后差。

Objective To analyze the correlative risk factors and prognosis of transfusion-related acute lung injury （TRALI） in the patients who had received blood transfusion. Methods Thirty seven patients with TRALI froln 2008 to 2014 were compared with the control of 58 cases for gender, age and clinical index, and possible independent risk factors that might influence TRALI were discussed. Results Compared with the control without TRALI, risk factors for TRALI included HLA antibodies II, transfusion, shock, smoking and hepatic disorders. Patients with TRALI had a higher mortality when compared with the control （X2= 49.056, P〈0.05） . Conclusion The risk factors correlated to TRALI comprised of antibodies against HLA II, blood transfusion, shock, and history of smoking and hepatic diseases. Patients with TRALI had bad prognoses. Post-operative intensive cure is the critical for avoidance of TRALI.