静脉输血法操作并发症

静脉输血法操作并发症 输血作为一种治疗手段已广泛应用于临床实践中。输血虽然有不可替代的治疗作用，但同时应当注意血液制品也有潜在的危险性，再加之由于医务人员的操作及病人的体质等原因，仍有3%-10%病人可发生不同程度的不良反应及相关疾病，如:非溶血性发热反应、过敏反应和变态反应、溶血反应、循环负荷过重(肺水肿)、出血倾向、枸橼酸钠中毒反应等等，因此必须严密观察输血后的并发症，积极的给予预防和处理。本节分述如下。 一 非溶血性发热反应 ? 发生原因 1. 外来性或内生性致热原:如蛋白质、细菌的代谢产物或死菌等， 污染保存液或输血用具，输血后即可引起发热反应。 2. 免疫反应:病人血内有白细胞凝集素、白细胞抗HLA、粒细胞特 异性抗体或血小板抗体，输血时对所输入的白细胞和血小板发生 作用，引起发热。主要出现在反复输血的病人或经产妇中。 ? 临床现 发生在输血过程中或输血后1~2小时内，初起发冷或寒颤;继之体温逐渐上升，可高达39~40?，伴有皮肤潮红、头痛、恶心、呕吐等症状，多数患者血压无变化，症状持续时间长短不一，多于数小时内缓解，少有超过24小时者;少数反应严重者可出现抽搐、呼吸困难、血压下降，甚至昏迷。 ? 预防及处理 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 1. 严格管理血库保养液和输血用具，采用无热原技术配制保养液， 严格清洗、消毒采血和输血用具，或用一次性输血器，可去除致 热原。 2. 输血前进行白细胞交叉配合试验，选用洗涤红细胞或用尼龙滤柱 过滤血液移除大多数粒细胞和单核细胞，可以减少免疫反应所致 的发热。 3. 一旦发生发热反应，立即停止输血，所使用过的血液废弃不用。 如病情需要可另行配血输注。 4. 遵医嘱予抑制发热反应的药物如阿司匹林，首次剂量1g，然后每 小时一次，共3次;伴寒战者予以抗组胺药物如异丙嗪25mg或度 冷丁50mg等对症治疗;严重者予以肾上腺皮质激素。 5. 对症处理:高热时给予物理降温，畏寒、寒战时应保暖，给予热 饮料、热水袋，加盖厚被等积极处理。严密观察体温、脉搏、呼 吸和血压的变化并。 二 过敏反应 ? 发生原因 1. 输入血液中含有致敏物质(如献血员在献血前4小时内曾用过可 致敏的药物或食物)。 2. 患者呈过敏体质，输入血液中的异体蛋白质同过敏机体组织细胞 结合，形成完全抗原而致敏所致。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 3. 多次输血的病员，可产生过敏性抗体，抗原和抗体相互作用而产 生过敏反应。 ? 临床表现 多数病人发生在输血后期或即将结束时，也可在输血刚开始时发生。表现轻重不一，轻者出现皮肤局限性或全身性红斑、荨麻疹和瘙痒、轻度血管神经性水肿(表现为眼脸、口唇水肿);严重者出现咳嗽、呼吸困难、喘鸣、面色潮红、腹痛、腹泻、神志不清、休克等症状，可危及生命。 ? 预防及处理 1. 勿选用有过敏史的献血员。 2. 献血员在采血前4小时内不宜吃高蛋白、高脂肪饮食，宜食用少 量清淡饮食或糖水。 3. 既往有输血过敏史者应尽量避免输血，若确实因病情需要须输血 时，应输注洗涤红细胞或冰冻红细胞，输血前半小时口服抗组胺 药或使用类固醇类药物。 4. 输血前详细询问患者的过敏史，了解患者的过敏原，寻找对该过 敏原无接触史的供血者。 5. 病人仅表现为局限性皮肤瘙痒、荨麻疹或红斑时，可减慢输血速 度，不必停止输血，口服抗组胺药如苯海拉明25mg，继续观察; 反应重者须立即停止输血，保持静脉通畅，严密观察患者的生命 体征，根据医嘱给予0.1%肾上腺素0.5~1ml 皮下注射。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 6. 过敏反应严重者，注意保持呼吸道通畅，立即予以高流量吸氧; 有呼吸困难或喉头水肿时，应及时作气管插管或气管切开，以防 窒息;遵医嘱给予抗过敏药物，如盐酸异丙嗪25mg肌肉注射，地 塞米松5mg静脉注射;必要时行心肺功能监护。 三 溶血反应 ? 发生原因 1. 输入异型血:即供血者和受血者血型不符，造成血管内溶血，一 般输入10~15ml即可产生症状。 2. 输血前红细胞已被破坏发生溶血:如血液贮存过久、保存温度不 当(血库冰箱应恒温4?)、血液震荡过剧、血液内加入高渗或低 渗溶液或影响PH值的药物、血液受到细菌污染等，均可导致红细 胞大量破坏。 3. Rh因子所致溶血:人类红细胞除含有A、B凝集原外，还有另一 种凝集原，称Rh因子。我国人口99%为阳性，1%为阴性。Rh阴性 者接受Rh阳性血液后，其血清中产生抗Rh阳性抗体，当再次接 受Rh阳性血液时可发生溶血反应。一般在输血后1-2小时发生， 也可延迟至6-7天后出现症状。 4. 输入未被发现的抗体所致延迟性的溶血反应。 ? 临床表现 1. 为输血中最严重的反应。开始阶段，由于红细胞凝集成团，阻塞 部分小血管，可引起头胀痛、面部潮红、恶心呕吐，心前区压迫application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 感、四肢麻木、腰背剧烈疼痛和胸闷等症状。中间阶段，由于凝 集的红细胞发生溶解，大量血红蛋白散布到血浆中，可出现黄疸 和血红蛋白尿，同时伴有寒战、高热、呼吸急促和血压下降等症 状。最后阶段，由于大量血红蛋白从血浆中进入肾小管，遇酸性 物质变成结晶体，致使肾小管堵塞;又因为血红蛋白的分解产物 使肾小管内皮缺血、缺氧而坏死脱落，也可导致肾小管堵塞。病 人出现少尿、无尿等急性肾功能衰竭症状，可迅速死亡。 2. 溶血程度较轻的延迟性溶血反应可发生在输血后7~14天，表现为 不明原因的发热、贫血、黄疸和血红蛋白尿等。 3. 还可伴有出血倾向，引起出血。 ? 预防及处理 1. 认真做好血型鉴定和交叉配血试验。 2. 加强工作责任心，严格核对病人和供血者姓名，血袋号和配血报 告有无错误，采用同型输血。 3. 采血时要轻拿轻放，运送血液时不要剧烈震荡;严格观察储血冰 箱温度，并详细记录，严格执行血液保存规则，不可采用变质血 液。 4. 一旦怀疑发生溶血，应立即停止输血，维持静脉通路，及时 医生。 5. 溶血反应发生后，立即抽取受血者静脉血加肝素抗凝剂，分类血 浆，观察血浆色泽，若呈粉红色，可协助诊断，同时测定血浆游 离血红蛋白量。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 6. 核对受血者与供血者姓名和ABO血型、Rh血型。用保存于冰箱 中的受血者与供血者血样、新采集的受血者血样、血袋中血样， 重做ABO血型、Rh血型、不规则抗体及交叉配血试验。 7. 抽取血袋中血液做细菌学检验，以排除细菌污染反应。 8. 维持静脉输液，以备抢救时静脉给药。 9. 口服或静脉滴注碳酸氢钠，以碱化尿液，防止和减少血红蛋白结 晶阻塞肾小管。 10. 双侧腰部封闭，并用热水袋热敷双侧肾区或双肾超短波透热疗 法，以解除肾血管痉挛，保护肾脏。 11. 严密观察生命体征和尿量、尿色的变化并记录。同时做尿血红蛋 白测定。对少尿、无尿者，按急性肾功能衰竭护理。如出现休克 症状，给予抗休克治疗。 四 循环负荷过重(急性左心衰) ? 发生原因 由于输血速度过快，短时间内输入过多血液，使循环血容量急剧增加，心脏负荷过重而引起心力衰竭和急性肺水肿。多见于心脏代偿功能减退的病人，如心脏病人、老年人、幼儿或慢性严重贫血病人(红细胞减少而血容量增多者)。 ? 临床表现 1. 表现为输血过程中或输血后突发头部剧烈胀痛、胸紧、呼吸困难、 发绀、咳嗽、大量血性泡沫痰。严重者可导致死亡。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 2. 体查:病人常端坐呼吸、颈静脉怒张、听诊肺部有大量水泡音、 中心静脉压升高。 3. 胸部摄片显示肺水肿影像。 ? 预防及处理 1. 严格控制输血速度和短时间内输血量，对心、肺疾患者或老年、 儿童尤应注意。 2. 出现肺水肿症状，立即停止输血，及时与医生联系，配合抢救。 协助病人取端坐位，两腿下垂，以减少回心血量，减轻心脏负担。 3. 加压给氧，可使肺泡内压力增高，减少肺泡内毛细血管渗出液的 产生;同时给予20%~30%酒精湿化吸氧，但要注意吸入时间不可 过长，以免引起乙醇中毒。 4. 遵医嘱予以镇静、镇痛、利尿、强心、血管扩张剂等药物治疗以 减轻心脏负荷。同时应严密观察病情变化并记录。 5. 清除呼吸道分泌物，保持呼吸道通畅，定时给病人拍背，协助排 痰，并指导病人进行有效呼吸。 6. 必要时用止血带进行四肢轮扎，每隔5~10min轮流放松一侧肢体 的止血带，可有效地减少静脉回心血量，待症状缓解后，逐步解 除止血带。 7. 心理护理，耐心向其简要解释检查和治疗的目的，以减轻患者的 焦虑和恐惧。 五 出血倾向 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check ? 发生原因 1. 稀释性血小板减少:库存血超过3小时后，血小板存活指数仅为 正常的60%，24小时及48小时后，分别降为12%和2%，若大量 输入无活性血小板的血液，导致稀释性血小板减少症。 2. 凝血因子减少:库存血液中，血浆中第?、?、?因子都会减少。 3. 枸橼酸钠输入过多:枸橼酸盐与钙离子结合，使钙离子下降，从 而导致凝血功能障碍。 4. 弥散性血管内凝血(DIC)、输血前使用过右旋糖酐等扩容剂等。 5. 长期反复输血。 ? 临床表现 患者创面渗血不止或手术野渗血不止，手术后持续出血;非手术部位皮肤、黏膜出现紫癜、瘀斑、鼻衄、牙龈出血、血尿、消化道出血、静脉穿刺处出血等。凝血功能检查可发现PT、APTT、PIT明显降低。 ? 预防及处理 1. 短时间内输入大量库存血时应严密观察病人意识、血压、脉搏等 变化注意皮肤、黏膜或手术伤口有无出血。 2. 尽可能的输注保存期较短的血液，情况许可时每输库血3~5单位， 应补充鲜血1单位。即每输1500ml库血即给予鲜血500ml，以补 充凝血因子。 3. 若发现出血表现，首先排除溶血反应，立即抽血做出血、凝血项 目检查，查明原因，输注新鲜血、血小板悬液，补充各种凝血因 子。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 六 枸橼酸钠中毒反应 ? 发生原因 大量输血的同时输入大量枸橼酸钠，如肝功能不全，枸橼酸钠尚未氧化即和血中游离钙结合而使血钙下降，导致凝血功能障碍、毛细血管张力减低、血管收缩不良和心肌收缩无力等。 ? 临床表现 手足搐搦、出血倾向、血压下降、心率减慢，甚至心跳骤停;心电图示QT时间延长，ST段延长，T波低平倒置;血液化验血清钙小于2.2mmol/L。 ? 预防及处理 1. 严密观察病人的反应，慎用碱性药物，注意监测血气和电解质化 验结果，以维持体内水、电解质和酸碱的平衡。 2. 每输注库血100ml，须按医嘱静脉注射10%葡萄糖酸钙或氯化钙 10ml，以补充钙离子。 七 细菌污染反应 ? 发生原因 1. 采血袋、保养液及输血器具未消毒或消毒不彻底。 2. 献血者皮肤未经严格消毒或在有化脓病灶的皮肤处穿刺采血，或 献血者有菌血症。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 3. 采血环境无菌状况不符合要求，采血完后针头帽拔出过早使空气 进入采血袋。 ? 临床表现 烦躁不安、剧烈寒战，继之高热、呼吸困难、发绀、腹痛，可出现血红蛋白尿和急性肾功能衰竭、DIC、中毒性休克等。 ? 预防及处理 1. 采血到输血的全过程中，各个环节都要严格遵守无菌操作。 2. 血袋内血制品变色或浑浊、有絮状物、较多气泡等任何可疑迹象 均可以认为有细菌污染可能而废弃不用。 3. 一旦发现，立即停止输血，及时通知医生。 4. 剩余血和病员血标本送化验室，做血培养和药敏试验。 5. 定时测量体温、脉搏、呼吸和血压，高热者，给予物理降温。准 确记录出入液量，严密观察病情变化，早期发现休克症状，积极 配合抗休克、抗感染治疗。 八 低体温 ? 发生原因 输入的血液温度过低，或输血过快、过量。 ? 临床表现 病人出现寒冷或寒颤，皮肤冰冷，心律紊乱，监测体温降至30?左右。 ? 预防及处理 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 1. 将大量备用的库血放在温度适宜的环境中自然升至室温再输入， 也可以用热水袋加温输血的肢体。 2. 大量、快速输血时将房间温度控制在24-25?。 3. 注意给患者保温，避免不必要的躯体暴露;输血过程中使用温热 的盐水作为冲洗液;低体温者给予热水袋保暖。 4. 密切观察并记录患者的体温变化。使用能测量35.5?以下的体温 计。 九 疾病传播 ? 发生原因 1. 献血员患有感染性疾病，如乙型、丙型病毒性肝炎、爱滋病等， 未能被检出，患者误用了带有病原体的血液。 2. 采血、贮血、输血操作过程中血液被污染。 ? 临床表现 输血后一段时间，出现经输血传播的相关疾病的临床表现。常见的疾病有:乙肝、丙肝、艾滋病、巨细胞病毒感染、梅毒、黑热病、回归热、丝虫病和弓形体病等。 ? 预防及处理 1. 严格掌握输血适应证，非必要时应避免输血。 2. 杜绝传染病人和可疑传染病人献血。 3. 严格对献血者进行血液和血液制品的。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 4. 在血液制品生产过程中采用加热或其他有效的方法灭活病毒。 5. 鼓励自体输血。 6. 严格对各类器械进行消毒，在采血、贮血和输血操作的各个环节， 认真执行无菌操作。 7. 对已出现输血传染疾病者，报告医生，因病施治。 十 液血胸 ? 发生原因 多见于外科手术后留置颈静脉套管针的患者，经套管针输入血液，由于医护人员穿刺技术或病人烦躁不安，不能配合等原因，导致套管针穿破静脉管壁并进入胸腔，使输注的血液进入胸腔所致。 ? 临床表现 进行性呼吸困难，口唇及皮肤发绀;查体可见患侧胸部肿胀、隆起、呼吸运动减弱;纵隔向健侧移位，叩诊由浊音到实音，呼吸音减弱或者消失。X线胸片可明确诊断。 ? 预防及处理 1. 输血前向病人作好解释工作，取得合作。对烦躁不安者，穿刺前 予以镇静剂。同时，提高医务人员留置套导管针的穿刺水平。 2. 输血前认真检查留置套管针有无外漏，确定无外漏后方可输血。 3. 疑有外漏者，立即取下输血管，用注射器接套管针反复回抽，如 无见回血，迅速拔出套管针。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 4. 已发生液血胸者，用注射器在右胸第二肋下穿刺，可取得血性胸 液。立即行胸腔闭式引流，留取引流液化验，并按胸腔闭式引流 术进行护理。 5. 改用其他静脉通路继续输血、输液。 6. 严密观察病情变化，监测血压、脉搏、呼吸、血氧饱和度，并记 录。 十一 空气栓塞、微血管栓塞 ? 发生原因 1. 输血导管内空气未排尽。 2. 导管连接不紧，有缝隙。 3. 加压输血时，无人在旁看守。 ? 临床表现 随进入的气体量多少不同，临床表现不同，当有大量气体进入时，病人可突发乏力、眩晕、濒死感，胸部感觉异常不适，或有胸骨后疼痛，随即出现呼吸困难和严重紫绀。 ? 预防及处理 1. 输血前必须把输血管内空气排尽，输血过程中密切观察;加压输 血时应专人守护，不得离开病人，及时更换输血袋。 2. 进行锁骨下静脉和颈外静脉穿刺时，术前让病人取仰卧位，头偏 向对侧，尽量使头后仰，然后屏气，深吸气后憋住气，再用力做 呼气运动，经上述途径留置中心静脉导管后，随即摄胸部平片。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 3. 拔除较粗、近胸腔的静脉导管时，必须严密封闭穿刺点。 4. 若发生空气栓塞，立即停止输血，及时通知医生，积极配合抢救， 安慰病人，立即为病人取左侧卧位和头低脚高位，头低脚高位时 可增加胸腔内压力，以减少空气进入静脉;左侧卧位可使肺动脉 的位置低于右心室，气体则向上飘移到右心室尖部，避开肺动脉 口，由于心脏搏动将空气混成泡沫，分次少量进入肺动脉内。 5. 给予高流量氧气吸入，提高病人的血氧浓度，纠正严重缺氧状态。 6. 每隔15分钟观察病人神志变化，监测生命体征，直至平稳。 7. 严重病例须气管插管人工通气，出现休克症状时及时抗休克治疗。 十二 移植物抗宿主反应 ? 发生原因 1. 免疫缺陷或功能低下病人多次接受输血。 2. 免疫功能正常者，供血者的纯合子人白细胞抗原(HLA)输入受 血者的杂合子HLA后产生的T细胞所引起的一种罕见的致命并发 症。 ? 临床表现 输血后7~14天出现发热、皮肤出现红斑、呼吸困难、肝脾肿大等排斥反应表现。 ? 预防及处理 1. 避免长期反复输血。 2. 尽量输入经过放射线照射的血制品，以灭活血液中的淋巴细胞。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 3. 遵医嘱应用类固醇、环磷酰胺、T淋巴细胞抑制剂等积极抗排斥 反应治疗。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check