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Blood：输血相关的循环超负荷和急性肺损伤的管理！

2019-04-02 MedSci MedSci原创

TACOTRALI输血二次打击模型
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输血相关循环超负荷(TACO)和输血相关急性肺损伤(TRALI)都是急性呼吸窘迫综合征，发生在输血后的6小时内。TACO和TRALI是导致输血相关死亡的主要原因，尚无针对性的治疗方法。在诊断上，仍不能很好的将TACO和TRALI与导致肺损伤和/或液体过负荷的潜在原因甚至是TACO和TRALI两者区分开来。TACO的特点是肺静水性(心源性)水肿，而TRALI表现为肺渗透性(非心源性)水肿。这两种综合

输血相关循环超负荷(TACO)和输血相关急性肺损伤(TRALI)都是急性呼吸窘迫综合征，发生在输血后的6小时内。TACO和TRALI是导致输血相关死亡的主要原因，尚无针对性的治疗方法。

在诊断上，仍不能很好的将TACO和TRALI与导致肺损伤和/或液体过负荷的潜在原因甚至是TACO和TRALI两者区分开来。TACO的特点是肺静水性(心源性)水肿，而TRALI表现为肺渗透性(非心源性)水肿。这两种综合征的病理生理均复杂且未完全明确。

二次打击模型被认为是研究TACO和TRALI疾病病理的基础，其中第一次打击表示患者的临床情况，第二次打击由输注的血制品引发。

在TACO的发生过程中，心脏或肾损伤和与正性液体平衡发生第一次打击，而次优的液体管理或输血产品中的某些成分可能导致第二次打击。显而易见，除了输液量之外的其他因素在TACO的发生中也具有重要作用。

在TRALI的发生过程中，第一次打击可由炎症引发，而第二次打击被认为是由抗白细胞抗体或生物反应修饰所引发的。

John W. Semple等人回顾了TACO和TRALI最新的临床定义、诊断策略、病理生理学机制和潜在治疗。应进行更多的研究来更好地理解TACO和TRALI的病理生理，发现更多的生物标志物，将有助于提高这类危及生命的输血反应的诊断和治疗。

相关资源：Murray肺损伤评分

原始出处：
John W. Semple， Johan Rebetz and Rick Kapur. Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood 2019 ：blood-2018-10-860809； doi： https：//doi.org/10.1182/blood-2018-10-860809 

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    2019-08-25 zhaojie88

    #超负荷#

    0

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    2019-04-04 windight

    #输血#

    0

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    2019-04-04 仁医06

    #急性肺损伤#

    0

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    2019-04-04 ms3046638856685384

    #损伤#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1813539, encodeId=897c18135393d, content=<a href='/topic/show?id=c21a92930ba' target=_blank style='color:#2F92EE;'>#超负荷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92930, encryptionId=c21a92930ba, topicName=超负荷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 25 23:42:00 CST 2019, time=2019-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259710, encodeId=3d4a1259e1024, content=<a href='/topic/show?id=569c9382389' target=_blank style='color:#2F92EE;'>#输血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93823, encryptionId=569c9382389, topicName=输血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec9955, createdName=windight, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395401, encodeId=87e91395401d2, content=<a href='/topic/show?id=d051523897d' target=_blank style='color:#2F92EE;'>#急性肺损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52389, encryptionId=d051523897d, topicName=急性肺损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397736, encodeId=548a139e7368b, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503316, encodeId=fd731503316de, content=<a href='/topic/show?id=67a7821250e' target=_blank style='color:#2F92EE;'>#肺损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82125, encryptionId=67a7821250e, topicName=肺损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=05329610584, createdName=tastas, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364049, encodeId=b79e3640499f, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Wed Apr 03 08:56:20 CST 2019, time=2019-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364016, encodeId=898736401660, content=很好啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/06/15/376de562705ccd8a43dfc3b347a3b5ff.jpg, createdBy=f58a2381667, createdName=蝴蝶A , createdTime=Tue Apr 02 21:04:12 CST 2019, time=2019-04-02, status=1, ipAttribution=)]
    2019-04-04 tastas

    #肺损伤#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1813539, encodeId=897c18135393d, content=<a href='/topic/show?id=c21a92930ba' target=_blank style='color:#2F92EE;'>#超负荷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92930, encryptionId=c21a92930ba, topicName=超负荷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 25 23:42:00 CST 2019, time=2019-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259710, encodeId=3d4a1259e1024, content=<a href='/topic/show?id=569c9382389' target=_blank style='color:#2F92EE;'>#输血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93823, encryptionId=569c9382389, topicName=输血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec9955, createdName=windight, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395401, encodeId=87e91395401d2, content=<a href='/topic/show?id=d051523897d' target=_blank style='color:#2F92EE;'>#急性肺损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52389, encryptionId=d051523897d, topicName=急性肺损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397736, encodeId=548a139e7368b, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503316, encodeId=fd731503316de, content=<a href='/topic/show?id=67a7821250e' target=_blank style='color:#2F92EE;'>#肺损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82125, encryptionId=67a7821250e, topicName=肺损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=05329610584, createdName=tastas, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364049, encodeId=b79e3640499f, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Wed Apr 03 08:56:20 CST 2019, time=2019-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364016, encodeId=898736401660, content=很好啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/06/15/376de562705ccd8a43dfc3b347a3b5ff.jpg, createdBy=f58a2381667, createdName=蝴蝶A , createdTime=Tue Apr 02 21:04:12 CST 2019, time=2019-04-02, status=1, ipAttribution=)]
    2019-04-03 smartxiuxiu

    好

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1813539, encodeId=897c18135393d, content=<a href='/topic/show?id=c21a92930ba' target=_blank style='color:#2F92EE;'>#超负荷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92930, encryptionId=c21a92930ba, topicName=超负荷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 25 23:42:00 CST 2019, time=2019-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259710, encodeId=3d4a1259e1024, content=<a href='/topic/show?id=569c9382389' target=_blank style='color:#2F92EE;'>#输血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93823, encryptionId=569c9382389, topicName=输血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec9955, createdName=windight, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395401, encodeId=87e91395401d2, content=<a href='/topic/show?id=d051523897d' target=_blank style='color:#2F92EE;'>#急性肺损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52389, encryptionId=d051523897d, topicName=急性肺损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397736, encodeId=548a139e7368b, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503316, encodeId=fd731503316de, content=<a href='/topic/show?id=67a7821250e' target=_blank style='color:#2F92EE;'>#肺损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82125, encryptionId=67a7821250e, topicName=肺损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=05329610584, createdName=tastas, createdTime=Thu Apr 04 06:42:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364049, encodeId=b79e3640499f, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Wed Apr 03 08:56:20 CST 2019, time=2019-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364016, encodeId=898736401660, content=很好啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/06/15/376de562705ccd8a43dfc3b347a3b5ff.jpg, createdBy=f58a2381667, createdName=蝴蝶A , createdTime=Tue Apr 02 21:04:12 CST 2019, time=2019-04-02, status=1, ipAttribution=)]
    2019-04-02 蝴蝶A

    很好啊

    0