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输血相关循环超负荷:预防、识别和管理严重不良事件的循证策略

Transfusion-Associated Circulatory Overload: Evidence-Based Strategies to Prevent, Identify, and Manage a Serious Adverse Event.

作者信息

Henneman Elizabeth A, Andrzejewski Chester, Gawlinski Anna, McAfee Kelley, Panaccione Thomas, Dziel Kimberly

机构信息

Elizabeth A. Henneman is an associate professor, College of Nursing, University of Massachusetts Amherst, Massachusetts. Chester Andrzejewski Jr is medical director, System Transfusion Medicine Services, Baystate Health, Springfield, Massachusetts. Anna Gawlinski is an adjunct professor, UCLA School of Nursing, Los Angeles, California. Kelley McAfee is a doctoral student, College of Nursing, University of Massachusetts Amherst, Massachusetts. Thomas Panaccione is a nurse manager, Observation and Infusion Services, Baystate Health, Springfield, Massachusetts. Kimberly Dziel is a nurse manager, Baystate Health, Springfield, Massachusetts.

出版信息

Crit Care Nurse. 2017 Oct;37(5):58-65. doi: 10.4037/ccn2017770.

Abstract

Transfusion-associated circulatory overload (TACO) is a potentially life-threatening complication of blood transfusion and is associated with increased morbidity, length of stay (hospital and intensive care unit), and hospital costs. Bedside nurses play a key role in the prevention, identification, and reporting of this complication. A common misperception is that the most frequently encountered serious adverse event during transfusion is a hemolytic reaction in a patient who receives ABO-incompatible blood. In fact, the incidence of TACO-related fatalities is higher than fatalities caused by ABO-related hemolytic reactions. Surveillance and evidence-based strategies such as clinical decision support systems have the potential to reduce the incidence of TACO and mitigate its effects. Practical suggestions for conducting bedside transfusion surveillance and future directions for improving transfusion care are presented.

摘要

输血相关循环超负荷(TACO)是一种潜在的危及生命的输血并发症,与发病率增加、住院时间(医院和重症监护病房)延长以及医院费用增加相关。床边护士在该并发症的预防、识别和报告中起着关键作用。一种常见的误解是,输血期间最常遇到的严重不良事件是接受ABO血型不相合血液的患者发生的溶血反应。事实上,TACO相关死亡的发生率高于ABO相关溶血反应导致的死亡。诸如临床决策支持系统等监测和循证策略有可能降低TACO的发生率并减轻其影响。本文提出了进行床边输血监测的实用建议以及改善输血护理的未来方向。

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