冰冻单采血小板与新鲜单采血小板临床应用效果评价
|
摘要
目的通过冰冻单采血小板与新鲜单采血小板临床疗效与安全性的回顾性病例对照分析,探讨冰冻单采血小板的临床应用价值。方法利用医院临床用血全程闭环智能路径管理与评价信息系统检索2014年8月-2016年12月血小板输注病例资料2 035例,并筛选出456例纳入临床病例对照研究;根据输注血小板种类分为冰冻单采血小板组(A组,n=199)和新鲜单采血小板组(B组,n=257)。通过对比分析两组病例基本资料、有效性指标及安全性指标,评价冰冻单采血小板的临床应用价值。结果 1)A、B两组病例分别占43.6%(199/456)、56.4%(257/456);A、B组间性别、年龄和内科、外科病例构成比差异均不具统计学意义(P>0.05);2)199例A组病例共输注冰冻单采血小板2 275U,其中121例内科病例输注量占60.9%(1 385/2 275),78例外科病例输注量占39.1%8(890/2275);疾病分布中血液系统疾病输注量占49.2%(1 120/2 275),妇产科疾病输注量占10.6%(240/2 275),肿瘤放化疗疾病输注量占6.2%(140/2 275);ABO血型分布构成比分别为O型25.9%、A型22.9%、B型20.7%、AB型30.5%;3)A、B两组病例输血前、后Plt计数差异均具统计学意义(P<0.05);而两组间输血前和输后24 h Plt计数、差值、24 h CCI差异均不具统计学意义(P>0.05);4)A、B两组血小板输注有效率分别为76.9%、76.7%,组间差异不具统计学意义(P>0.05);两组间内科及外科病例疗效差异均不具统计学意义(P>0.05),但A组外科病例有效率(84.6%)高于B组外科病例(75.3%);B组内科与外科病例间疗效差异不具统计学意义(P>0.05),但A组内科与外科病例间疗效差异具统计学意义(P<0.05),外科病例血小板输注无效率(15.4%)明显低于内科病例(28.1%);5)A、B两组输血不良反应发生率分别为3.5%、4.7%,输血死亡率均为0,组间差异不具统计学意义(P>0.05)。结论冰冻单采血小板在临床治疗中与新鲜单采血小板具有同等的有效性和安全性,可广泛用于临床,特别是在外科止血疗效上具有一定的优势,但对反复输注或血小板输注无效病例应优先使用新鲜单采血小板。
Objective To evaluate the clinical value of apheresis platelets throught heanalysisof case control on the clinical efficacy and safety of cryopreserved apheresis platelets and fresh apheresis platelets. Methods 2 035 clinical cases of platelet transfusion in August 2014 to December 2016 by Using the closed loop intelligent path management and evaluation information system,456 cases were selected as control cases.Platelets were divided into the cryopreserved apheresis platelets group( group A,n = 199) and fresh apheresis platelets group( group B,n = 257) according to the transfused platelet type.The clinical application value of cryopreserved single platelets was evaluated by comparing the basic data,the effective indexes and safety indexes of the two groups. Results 1) The cases were 43. 6%( 199/456) in A groups,and 56. 4%( 257/456) in B groups,there were no significant difference in gender,age and medical and surgical cases between A and B group( P>0. 05); 2) 199 cases in group A were cryopreserved platelets of 2 275 U,including 121 medicine cases,the total amount of transfusion was about 60. 9%( 1 385/2 275),78 surgical cases accounted for 39. 1%( 890/2 275); In the distribution of diseases,the blood system diseases accounted for 49. 2%( 1 120/2 275),the total amount of obstetrics and gynecology disease infusion accounted for 10. 6%( 240/2 275),and the amount of tumor radiotherapy and chemotherapy accounted for 6. 2%( 140/2 275); The proportion of ABO blood type distribution was O type 25. 9%,A type 22. 9%,Btype 20. 7%,ABtype 30. 5%,respectively; 3) The Plt counts of group A and B were significantly different before and after transfusion( P<0. 05). But there was no significant difference between the two groups of cases before transfusion and 24 h Plt count after transfusion,the Plt counts difference,and 24 h CCI( P>0. 05); 4) The effective rates of platelet transfusion in group A and B were 76. 9% and 76. 7%, respectively. Which has no significant difference between the two groups( P> 0. 05)). There was no significant difference between the two groups in medical and surgical cases( P> 0. 05),but the effective rate of surgical cases in group A( 84. 6%) was higher than that in B group( 75. 3%).The difference effect of medicine and surgery cases in B group were not statistically significant( P>0. 05),but the difference effect of medicine and surgery cases in A group was statistically significant( P<0. 05),platelet transfusion inefficient in surgical cases( 15. 4%) was significantly lower than that of cases( 28. 1%); 5) The incidence of adverse reactions of blood transfusion was 3. 5%,4. 7% in group A and B,and the blood transfusion mortality rate was zero,the difference was not statistically significant( P> 0. 05).Conclusion The clinical effectiveness and safety of cryopreserved apheresis platelets are similar to those of fresh apheresis platelets,and the former can be widely Used in clinic,in particular,it has certain advantages in the surgical hemostatic effect. but for repeated infusion cases or platelet transfusion ineffective cases should be given priority to fresh apheresis platelets.
Objective To evaluate the clinical value of apheresis platelets throught heanalysisof case control on the clinical efficacy and safety of cryopreserved apheresis platelets and fresh apheresis platelets. Methods 2 035 clinical cases of platelet transfusion in August 2014 to December 2016 by Using the closed loop intelligent path management and evaluation information system,456 cases were selected as control cases.Platelets were divided into the cryopreserved apheresis platelets group( group A,n = 199) and fresh apheresis platelets group( group B,n = 257) according to the transfused platelet type.The clinical application value of cryopreserved single platelets was evaluated by comparing the basic data,the effective indexes and safety indexes of the two groups. Results 1) The cases were 43. 6%( 199/456) in A groups,and 56. 4%( 257/456) in B groups,there were no significant difference in gender,age and medical and surgical cases between A and B group( P>0. 05); 2) 199 cases in group A were cryopreserved platelets of 2 275 U,including 121 medicine cases,the total amount of transfusion was about 60. 9%( 1 385/2 275),78 surgical cases accounted for 39. 1%( 890/2 275); In the distribution of diseases,the blood system diseases accounted for 49. 2%( 1 120/2 275),the total amount of obstetrics and gynecology disease infusion accounted for 10. 6%( 240/2 275),and the amount of tumor radiotherapy and chemotherapy accounted for 6. 2%( 140/2 275); The proportion of ABO blood type distribution was O type 25. 9%,A type 22. 9%,Btype 20. 7%,ABtype 30. 5%,respectively; 3) The Plt counts of group A and B were significantly different before and after transfusion( P<0. 05). But there was no significant difference between the two groups of cases before transfusion and 24 h Plt count after transfusion,the Plt counts difference,and 24 h CCI( P>0. 05); 4) The effective rates of platelet transfusion in group A and B were 76. 9% and 76. 7%, respectively. Which has no significant difference between the two groups( P> 0. 05)). There was no significant difference between the two groups in medical and surgical cases( P> 0. 05),but the effective rate of surgical cases in group A( 84. 6%) was higher than that in B group( 75. 3%).The difference effect of medicine and surgery cases in B group were not statistically significant( P>0. 05),but the difference effect of medicine and surgery cases in A group was statistically significant( P<0. 05),platelet transfusion inefficient in surgical cases( 15. 4%) was significantly lower than that of cases( 28. 1%); 5) The incidence of adverse reactions of blood transfusion was 3. 5%,4. 7% in group A and B,and the blood transfusion mortality rate was zero,the difference was not statistically significant( P> 0. 05).Conclusion The clinical effectiveness and safety of cryopreserved apheresis platelets are similar to those of fresh apheresis platelets,and the former can be widely Used in clinic,in particular,it has certain advantages in the surgical hemostatic effect. but for repeated infusion cases or platelet transfusion ineffective cases should be given priority to fresh apheresis platelets.
引文
[1]Vadhanraj S,Kavanagh JJ,Freedman RS,et al.Safety and efficacy of transfusions of autologo Us cryopreserved platelets derived from recombinant h Uman thrombopoietin to support chemotherapy-associated severe thrombocytopenia:a randomised cross-over st Udy.Lancet,2002,359(9324):2145-52.
[2]赵树铭,成晓玲,李书武,等.冰冻和常规保存机采血小板在血液病患者中的应用评价.重庆医学,2003,32(3):289-290.
[3]胡丽华.临床输血学检验,3版.北京:人民卫生出版社,2012:150.
[4]丁国良,秦卫胜,赵林园,等.冰冻血小板的关键制备技术及临床应用研究.中国实验血液学杂志,2016,24(4):1226-1231.
[5]Navarro SR,Tamb Urri BR,Vírseda CI,et al.[Use of frozen platelets in massive limb trauma.Revista Espanola De Anestesiologia Y Reanimacion,2015,62(4):233.
[6]Barnard MR,Macgregor H,Ragno G,et al.Fresh,liquid-preserved,and cryopreserved platelets:adhesive surface receptors and membrane procoagulant activity.Transfusion,2010,39(8):880-888.
[7]Pérezferrer A,Navarrosuay R,Viejollorente A,et al.In vitro thromboelastometric evaluation of the efficacy of frozen platelet transfusion.Thrombosis Research,2015,136(2):348-53.
[8]Towell BL,Levine S P,Anderson J L.A comparison of frozen and fresh platelet concentrates in the support of thrombocytopenic patients.Transfusion,2010,26(6):525-530.
[9]张学英,李玲玲,韩志勇.冰冻血小板与新鲜血小板的疗效比较.临床和实验医学杂志,2013,12(1):26-27.
[10]饶美英,叶水文,张楠,等.多次输血患者血小板抗体检测及输注效果分析.中国输血杂志,2013,26(9):891-892.
[11]沈胜建,赵明峰,张宇辰.血液病患者单采血小板输注无效的原因及对策.山东医药,2014,54(37):4-7
[2]赵树铭,成晓玲,李书武,等.冰冻和常规保存机采血小板在血液病患者中的应用评价.重庆医学,2003,32(3):289-290.
[3]胡丽华.临床输血学检验,3版.北京:人民卫生出版社,2012:150.
[4]丁国良,秦卫胜,赵林园,等.冰冻血小板的关键制备技术及临床应用研究.中国实验血液学杂志,2016,24(4):1226-1231.
[5]Navarro SR,Tamb Urri BR,Vírseda CI,et al.[Use of frozen platelets in massive limb trauma.Revista Espanola De Anestesiologia Y Reanimacion,2015,62(4):233.
[6]Barnard MR,Macgregor H,Ragno G,et al.Fresh,liquid-preserved,and cryopreserved platelets:adhesive surface receptors and membrane procoagulant activity.Transfusion,2010,39(8):880-888.
[7]Pérezferrer A,Navarrosuay R,Viejollorente A,et al.In vitro thromboelastometric evaluation of the efficacy of frozen platelet transfusion.Thrombosis Research,2015,136(2):348-53.
[8]Towell BL,Levine S P,Anderson J L.A comparison of frozen and fresh platelet concentrates in the support of thrombocytopenic patients.Transfusion,2010,26(6):525-530.
[9]张学英,李玲玲,韩志勇.冰冻血小板与新鲜血小板的疗效比较.临床和实验医学杂志,2013,12(1):26-27.
[10]饶美英,叶水文,张楠,等.多次输血患者血小板抗体检测及输注效果分析.中国输血杂志,2013,26(9):891-892.
[11]沈胜建,赵明峰,张宇辰.血液病患者单采血小板输注无效的原因及对策.山东医药,2014,54(37):4-7