产科输血不良反应发生情况及相关危险因素分析

目的:探讨产科输血不良反应发生情况及相关危险因素,为预防和应对产科输血不良反应的发生提供依据。方法:回顾性分析郑州大学第一附属医院2016年1月—2017年12月产科输血患者,发生输血不良反应的病例为观察组(75例,共76人次),无不良反应发生的病例为对照组(1 243例),分析产科输血不良反应情况,运用单因素和多因素Logistic回归分析输血不良反应相关的危险因素。结果:产科总输血2 778人次,产科总体输血人次不良反应发生率为2.74%(76/2 778),其中过敏反应发生率63.16%(48/76),非溶血性发热反应发生率23.68%(18/76),其他不良反应发生率13.16%(10/76)。两两比较中发现单采血小板不良反应率高于悬浮红细胞,差异有统计学意义(χ2=22.594,P<0.001);单采血小板不良反应率高于冷沉淀,差异有统计学意义(χ2=10.146,P=0.001)。按每袋血制品是否使用抗过敏药物进行分析,使用抗过敏药物和未使用两组比较,差异无统计学意义(χ2=0.025,P=0.874)。2组患者输血史、输血不良反应史、输血次数和输血种类比较差异有统计学意义(均P<0.05),产妇类型、过敏史比较差异无统计学意义(均P>0.05)。多因素Logistic回归分析显示,有输血史(OR=9.888,95%CI:5.813~16.820)是发生输血不良反应的危险因素,输血次数1次(OR=0.464,95%CI:0.277~0.777)是发生输血不良反应的保护因素。结论:有输血史及输血次数≥2次为产科输血不良反应的危险因素,因此应严格掌握输血适应证,合理输血。

Analysis of Adverse Reactions of Blood Transfusion and Related Risk Factors in Obstetrics

Objective：To investigate the occurrence and related risk factors of adverse reactions of obstetric blood transfusion, and to provide evidence for prevention and treatment of adverse reactions of obstetric blood transfusion. Methods: A retrospective analysis was made on obstetric patients who received blood transfusion from January 2016 to December 2017 in the First Affiliated Hospital of Zhengzhou University. The observation group (75 cases, a total of 76 times) had adverse transfusion reactions, while the control group (1 243 cases) had no adverse transfusion reactions. Analyze the adverse reactions of obstetric blood transfusion and analyze the risk factors related to adverse reaction of blood transfusion by univariate and multivariate Logistic regression analysis. Results: There was a total of 2 778 times for blood transfusion in obstetrics, and the incidence of adverse reactions in obstetrics was 2.74% (76/2 778), including allergic reaction (63.16%), non-hemolytic fever (23.68%) and other adverse reactions (13.16%). The adverse reaction rate of platelet collection was higher than that of suspended red blood cells of which the difference was statistically significant (χ2=22.594, P＜0.001), and the adverse reaction rate of platelet collection was higher than that of cryoprecipitation of which the difference was statistically significant (χ2=10.146, P=0.001). There was no significant difference between the two groups (χ2=0.025, P=0.874) according to whether antiallergic drugs were used in each bag of blood products. There were significant differences in blood transfusion history, adverse reaction history, times and types of blood transfusion between the two groups (all P＜0.05), and no significant differences in maternal type and allergic history (all P＞0.05). Multivariate logistic regression analysis showed that history of blood transfusion (OR=9.888, 95%CI: 5.813-16.820) was a risk factor for adverse transfusion reactions. One transfusion (OR=0.464, 95%CI: 0.277-0.777) was a protective factor for adverse transfusion reactions. Conclusions: Blood transfusion history and times of blood transfusion ≥2 are risk factors for adverse reactions of obstetric blood transfusion. Therefore, the indications of blood transfusion should be strictly controlled and blood transfusion should be reasonable.