悬浮红细胞储存时间对骨科手术患者输血不良反应的影响

Effects of different suspension red blood cell storage time on adverse reactions of transfusion in orthopedic surgery patients

目的:探讨悬浮红细胞储存时间对骨科手术患者发生输血不良反应的影响。方法:回顾性分析于2016年8月—2018年7月于成都市第三人民医院骨科住院并进行手术需要输血的患者共642例,根据输注的悬浮红细胞储存时间分为≤2周组(短期组,360例)和>2周组(长期组,282例),对比两组输血后的不良反应发生情况,比较两组输血前后的生化指标、电解质和凝血功能指标。结果:短期组患者不良反应发生率为1.39%,而长期组的不良反应发生率为3.90%,差异具有统计学意义(χ2=4.106,P=0.043),两组患者在输血前的指标包括血红蛋白(Hb)、红细胞压积(HCT)、血小板计数(PLT)、pH值、K+、Ca2+、总胆红素(TBIL)、直接胆红素(DBIL)和凝血功能等指标对比差异均无统计学意义(P>0.05),输血后两组患者的pH值和Ca2+水平均显著下降(P<0.05),而K+、TBIL和DBIL的水平均显著升高(P<0.05),其中长期组的K+、TBIL和DBIL均显著高于短期组(P<0.05)。结论:骨科手术患者输注储存时间较长(>2周)的悬浮红细胞后,其输血后的不良反应发生率显著增高,且血液中K+、TBIL和DBIL水平均显著增高。

Objective: To investigate the effects of different suspension red blood cell storage time on adverse reactions of transfusion in orthopedic surgery patients.Methods: A total of 642 patients who were hospitalized in the orthopedics department of Chengdu Third People’s Hospital from August2016 to July 2018 and required blood transfusion were divided into blood-storage-time ≤2 weeks(short-term group) and >2 weeks groups according to the infusion red blood cell storage time. Two weeks(long-term group), including 360 cases in the short-term group and 282 cases in the long-term group. The adverse reactions after transfusion were compared between the two groups. The biochemical indicators, electrolytes and coagulation parameters before and after transfusion were compared between the two groups.Results: The adverse reactions in the short-term group accounted for 1. 39%,which was significant less than that of the long-term group(3. 90%)(χ2=4. 106, P=0. 043). There were no significant differences in the indicators of Hb, HCT, PLT, pH, K+, Ca2+, TBIL, DBIL and coagulation function before transfusion(P>0. 05). The pH and Ca2+levels increased, while the levels of K+, TBIL, and DBIL decreased after transfusion in both groups. The levels of K+, TBIL,and DBIL of the long-term group were significantly higher than those of the short-term group(P<0. 05).Conclusion: After surgery, in the patients infused with long-term storage(>2 weeks) suspended red blood cells, the incidence of adverse reactions after transfusion increases significantly, and the levels of K+, TBIL, and DBIL in the blood increase too.