摘要
目的探讨血浆置换不良反应发生情况及影响因素。方法收集2013年2月—2019年6月在本院血液中心进行血浆置换治疗的121例危重症患者的临床资料,观察血浆置换后患者不良反应发生的情况,将121例患者中发生血浆置换不良反应者纳为发生不良反应组(n=38),其他纳为未发生不良反应组(n=83);将可能的影响因素纳入,如性别、年龄、职业,抗凝剂、置换液、有效循环血容量、血浆置换次数及机器报警致暂停治疗时间等,经检验初次分析可能的影响因素,并将差异具有统计学意义的变量纳为自变量,经多因素Logistic回归分析血浆置换危重症患者不良反应的影响因素。结果本组121例患者接受PE治疗,其中38例患者发生不良反应,发生率为31.40%;其中血浆过敏反应18例(14.88%),严重过敏反应3例(2.48%),低血压4例(3.31%),低血钙6例(4.96%),凝血5例(4.13%),其中严重凝血导致破膜1例(0.83%),以上不良反应均经有效处理后缓解;本研究单因素分析结果显示,两组患者的性别、年龄及职业比较,差异无统计学意义(P>0.05);发生不良反应组患者的抗凝剂、置换液、有效循环血容量及机器报警致暂停治疗时间与未发生不良反应组比较,差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,新鲜冰冻血浆、有效循环血容量下降、枸橼酸钠抗凝剂以及机器报警致暂停时间≥1 min是血浆置换发生不良反应的影响因素。结论血浆置换常见不良反应包括血浆过敏、低血压、低血钙及凝血反应,其中新鲜冰冻血浆、有效循环血容量下降、枸橼酸钠抗凝剂以及机器报警致暂停时间≥1min是PE发生不良反应的独立危险因素。
Objective To investigate the occurrence and influencing factors of adverse reactions of plasma exchange.Methods The clinical data of 121 critically ill patients who underwent plasma exchange treatment at the blood center of our hospital from February 2013 to June 2019 were collected to observe the occurrence of adverse reactions in patients after plasma exchange.Among 121 patients,those with adverse reactions of plasma exchange were included in the adverse reaction grouP(n=38),and the others were included in the non-adverse reaction grouP(n=83);Incorporate possible influencing factors,such as gender,age,occupation,anticoagulant,replacement fluid,effective circulating blood volume,number of plasma exchanges,and time for suspension of treatment caused by machine alarms,etc.After testing,the possible influencing factors were analyzed for the first time,and the variables with statistical significance were included as independent variables,and the influencing factors of adverse reactions in critically ill patients with plasma exchange were analyzed by multivariate Logistic regression.Results 121 patients in this grouPreceived PE treatment,of which 38 patients had adverse reactions,with an incidence rate of 31.40%.Among them,18 had plasma allergic reactions(14.88%),3 had severe allergic reactions(2.48%),and 4 had hypotension(3.31%),6 cases of hypocalcemia(4.96%),5 cases of coagulation(4.13%),and 1 case(0.83%)of membrane rupture caused by severe coagulation.The above adverse reactions were relieved after effective treatment;The univariate analysis results of this study showed that there was no statistically significant difference in the gender,age and occupation of the two groups of patients(P>0.05);the anticoagulant,replacement fluid,effective circulating blood volume and machine alarm of the adverse reaction grouPComparing the time of suspension of treatment with the grouPwithout adverse reactions,the difference was statistically significant(P<0.05);Conclusion:Common adverse reactions of plasma exchange include plasma
作者
韦雪芸
Wei-Xueyun(Wuming Hospital Affiliated to Guangxi Medical University,Department of Rheumatology and Immunology,GuangxiNanning530199)
基金
广西壮族自治区卫生和计划生育委员会自筹经费科研课题(编号:Z20180233)。
关键词
血浆置换
不良反应
发生率
影响因素
plasma exchange
adverse reactions
incidence
influencing factors
