摘要
目的参考美国输血不良反应诊断标准,对四川省20家三级医院2014年部分上报输血不良反应进行回顾性评估分级,对输血不良反应分级评估方法进行初步尝试,希望为日后输血不良反应分类分级评估标准的制定和输血预警系统的建立提供借鉴。方法随机抽取四川省19个地市20家三级医院2014年上报输血不良反应166例,根据患者输血前后生命体征的变化情况、临床症状、相关实验室检查等对输血不良反应进行重新诊断评估,从"不良反应类型的肯定程度"、"反应的严重程度"以及"反应与输血相关可能性的大小"3个方面进行分级。结果1)从"反应类型的肯定程度"方面分析,98.14%(158例)的输血不良反应能够根据患者临床表现进行较为准确的类型判断;1.86%(3例)的输血不良反应,患者未出现符合定义标准的明确临床表现,评估结果为"疑似"。2)从"反应严重程度"方面分析,93.98%(156例)为轻中度输血不良反应,可自行缓解或于临床干预后迅速缓解;6.02%(10例)为重度输血不良反应,临床症状严重,虽然于对症处理后缓解,但普遍缺少相关后续检查和原因追踪。3)从"反应与输血相关可能性的大小"方面分析,93.37%(155例)的不良反应经评估后"输血相关性极高",患者症状肯定是由输血原因导致;6.63%(11例)的不良反应则可能是由输血以外的其它原因导致的,存在并非输血不良反应的可能性。结论输血不良反应的评估分级能够增加输血不良反应判断结果的准确性和严谨性,有利于及时对患者进行后续检查和原因分析,避免输血不良反应错报漏报,提高输血安全,进而为日后输血不良反应分类分级标准的制定和输血预警系统的建立奠定基础。
Objective To evaluate and grade retrospectively several reported adverse transfusion reactions （ATRs） in 20 tertiary hospitals of Sichuan province in 2014 according to the American Diagnostic Criteria of ATRs, and to utilize grading evaluation methods tentatively in order to provide references for future establishment of classification standards and hemovigi- lance system. Methods 166 reported ATRs in 20 tertiary hospitals in 19 cities of Sichuan Province were selected randomly. Those ATRs were re-diagnosed and classified according to patients＇ vital signs, clinical symptoms and related laboratory tests, and then were evaluated and graded from ＂Case definition,＂ ＂Severity＂ and ＂Imputability＂. Results 1 ）. When evaluating and grading based on ＂case definition＂, 158 ATRs could be classified accurately based on patients＇ clinical manifestations （ATRs＇ type could be determined or substantially determined ）, accounting for 98.14%. 3 ATRs＇ type could not be determined accurately because the patients had no conditions which could meet the classified definition criteria definitely, accounting for 1.86%. 2）. When evaluating and grading based on ＂severity＂, 156 ATRs were mild or moderate reactions, which were self-mitigated or rapidly relieved after clinical intervention, accounting for 93.98%; 10 ATRs were severe reactions in which patients felt relieved after clinical intervention, accounting for 6.02%. Those ATRs lacked follow-up reason analysis and relevant laboratory tests. 3）. When evaluating and grading based on ＂imputability＂, 155 adverse reaction were ＂definite＂ reactions which showed extremely high correlation with transfusion and could not be explained by other conditions, accounting for 93.37%; 11 adverse reaction might be caused by other reasons and were not ATRs, accounting for 6.63%. Conclusion The evaluation and grading assessment on ATRs can increase the accuracy and preciseness of judgmentwhich is beneficial to follow-up examination and cause analysis. Thu
出处
《中国输血杂志》
北大核心
2017年第4期371-374,共4页
Chinese Journal of Blood Transfusion
