输血精ppt课件

04.05.2020,.,1,BLOODTRANSFUSION,陆志刚Tel:643353E-mail:gzluzhigang14-03-2013,04.05.2020,.,2,Section1outline,第一节概述,04.05.2020,.,3,Whatisbloodtransfusion?,TherapyraiseHemoglobinconcentration2.抗休克:控制输液输血速度,激素、升压药3.防治肾衰:碱化尿液、利尿、酸碱平衡4.防治DIC:血小板、凝血因子,抗纤溶、肝素5.换血疗法：血浆置换、血液置换,抢救治疗,04.05.2020,.,34,四、AnotherComplicationsofTransfusion其他输血并发症,BacterialContaminationReaction细菌污染反应Transfusion-relatedacutelunginjury(TRALI)输血相关性急性肺损伤Transfusion-associatedgraftversushostdisease(TA-GVHD)输血相关性移植物抗宿主病,04.05.2020,.,35,五、TheComplicationsofMassiveTransfusion大量输血的并发症,Circulatoryoverload循环超负荷Hypothermia低体温Electrolyteandacid-baseimbalance电解质和酸碱失衡(碱中毒、低血钙、高血钾等)Bleedingtendency出血倾向,04.05.2020,.,36,六、TransfusiontransmittedDiseases输血传播疾病,病毒性疾病：HepatitisAHepatitisBHepatitisC病毒性肝炎HIVinfectionandAIDS艾滋病毒感染、艾滋病HTLV/infectionandAdultT-cellleukemia(ATL)T细胞白血病Cytomegalovirus(CMV)infection巨细胞病毒感染非病毒性疾病：Syphilis梅毒、Malaria疟疾,04.05.2020,.,37,第四节成分输血,Section4componentbloodtransfusion,04.05.2020,.,38,红细胞,白细胞,血小板,血浆,血浆蛋白,细胞因子,有形成分,无形成分,全血,悬浮红细胞（浓缩红细胞）去白细胞红细胞洗涤红细胞-射线照射红细胞,新鲜冰冻血浆普通冰冻血浆,冷沉淀、凝血酶原复合物.,EPO、G-CSF、IL-2.,.,手工制备浓缩血小板,机器单采浓缩血小板,04.05.2020,.,39,ClinicalUsesofBloodComponents,一、RedBloodCells悬浮红细胞1.绝大多数外科手术输血2.普通单纯性贫血需要输血者3.小儿与老年病人需要输血者,04.05.2020,.,40,ClinicalUsesofBloodComponents,二、RedBloodCellsLeukocytesReduced去白细胞红细胞1.需要反复、经常输血支持治疗者2.准备作组织、器官移植需输血治疗者3.有非溶血性发热反应输血史需输血者4.体内已产生抗白细胞抗体需输血治疗者,04.05.2020,.,41,ClinicalUsesofBloodComponents,三、WashedRedBloodCells洗涤红细胞1.同少白细胞红细胞;2.免疫性溶血性贫血;3.阵发性睡眠性血红蛋白尿;4.新生儿溶血病换血;5.高钾血症，肝、肾功能障碍需输血支持治疗者。,04.05.2020,.,42,ClinicalUsesofBloodComponents,四、Platelets血小板,(一)platelettransfusionfortreatmentofactivebleeding治疗性血小板输注,1.血小板计数20109/L,伴有严重出血倾向者2.血小板功能异常,伴有出血倾向或需手术治疗者,04.05.2020,.,43,ClinicalUsesofBloodComponents,四、Platelets血小板,1.血小板数50109/L,要作创伤性检查或腹部手术2.血小板数100109/L,要作眼、脑等关键部位手术3.血小板数5109/L,要尽早输;110g/L、Hct0.33、Alb30g/L4.没有禁忌证。,禁忌证,适应证,04.05.2020,.,52,Bloodtransfusionisatherapy.Amajorclinicalindicationfortransfusiontherapyistheneedtoraisehematocrit,improveoxygen-carryingcapacity,restoreandmaintainthecirculatingbloodvolumeofinacutebloodloss.Probablymorethan50percentofthebloodtransfusionisinthesupportofsurgery.Anotherindicationistheneedforspecificcellularorproteincomponentssuchaserythrocytes,specificcoagulationfactorsorplatelets.,SUMMORY,04.05.2020,.,53,Despiteitslifesavingrole,therearerisksassociatedwithbloodtransfusion.Theimmunologiccomplicationsinvolvevariousformsofwhatareusuallythoughtastransfusionreactions,butmorerecentlythereisanincreasedinterestintheimmunomodulationeffectsoftransfusion.Nonimmunologiccomplicationsareusuallycausedbythephysicaleffectsofthebloodcomponentortransmissiondisease.Manyofthecomplicationsoftransfusionarecausedbytheleukocytescontainedinthebloodcomponents.,04.05.2020,.,54,Autologousblooddonationandtransfusionminimizestheprobabilityofadversereactionstotransfusionsuchastransmissionofdiseaseoralloimmunization.Itmaybeachievedbypreoperativecollectionandstorageofblood,immediatepreoperativephlebotomyandhemodilutionwithpostoperativereturnoftheblood,orreinfusionofbloodcollectedintraoperativelyandpostoperatively.Autologousdonationisidealforpatientswithrarebloodtypesorwithantibodiesthatmakecross-matchingdifficultorimpossible.,04.05.2020,.,55,复习思考题,一、输血适应证与合理输血原则？二、如何预防、诊断和抢救溶血性输血反应？三、自身输血的分类和禁忌证？,04.05.2020,.,56,推荐参考读物,基础输血学杨成民等主编输血治疗学陈小伍等主编TextbookofBloodBankandTransfusionMedicineRudmannSVed.2nd.2005TransfusionTherapy:ClinicalPrincipleandPracticeMurphyMFed.3rd2011,04.05.2020,.,57,输血专业网址推介,中国输血协会：输液疗法与输血医学：,04.05.2020,.,58,伟大的事业神圣的职业,如果我们能够选择了最能为人类的福利而劳动的职业，那