目的 调查儿科急诊非急诊手术患儿输血后红细胞恢复的影响因素。方法 回顾2020年1月—2020年12月期间广州市妇女儿童医疗中心珠江新城院区儿科急诊1月~18岁患儿的输血情况,其中分为Hb提升达预期组（n=93）,Hb提升未达预期组（n=156）,根据年龄、性别、体质量、是否恶性肿瘤、是否发热、有无延迟输血、输血前血红蛋白水平、输注红细胞类型情况,分析输血疗效及影响因素。结果 2组患儿的性别、年龄、体质量、有无恶性肿瘤、是否发热、输血等待时间、输血前后血红蛋白值、输注红细胞悬液量以及有无及时输血均无统计学差异;输注红细胞类型组间存在显著差异,Hb提升未达预期组更多输注了洗涤红细胞悬液（13.5% vs 5.4%,P=0.044）,输血后 Hb 值较低（中位数,73 g/L vs 84 g/L,P<0.001）,变化 Hb 值较小（中位数,18 g/L vs 30 g/L,P<0.001）,归因分析未发现影响因素。结论 输注洗涤红细胞可能是降低输血后红细胞提升的影响因素,输注洗涤红细胞时需严格输血指征同时注意红细胞提高预值的设定。

Objective To investigate the influencing factors of blood transfusion efficacy in patients without emergency operations in pediatric emergency．Methods A retrospective analysis of the blood transfusion of pediatric emergency children（1 month~ 18 year of age）in Zhujiang New Town Branch of Guangzhou Women and Children's Medical Center from January 2020 to December 2020 was carried out,patients were divided into Hb elevation up to expectation group（n=93）and Hb elevation not up to expectation group（n=156）．The efficacy of blood transfusion and the factors affecting it were analyzed according to age,gender,body mass,with or without malignant tumor,whether fever was present,whether there was delayed transfusion,pre-transfusion hemoglobin level,and the type of red blood cells transfused．Results There were no significant differences in gender,age,weight,malignant tumor,fever,waiting time for blood transfusion,hemoglobin level before and after blood transfusion,infusion volume of red blood cell suspension and whether had timely blood transfusion between the two groups．Significant differences were found between groups of transfused red blood cell types,with more washed red blood cell suspensions transfused in the Hb elevation not meeting expectations group（13.5% vs 5.4%,P=0.044）,which had lower post-transfusion Hb values（median,73 g/L vs 84 g/L,P<0.001）,and smaller change Hb values（median,18 g/L vs 30 g/L,P<0.001）,and attribution analysis did not reveal influencing factors．Conclusions Transfusion of washed red blood cell may be an influencing factor that reduces the RBCs elevation after transfusion．Attention should be paid to strict indications for washed red blood cell transfusion and setting the expected Hb level.

目的 探讨在COVID-19流行期间血库资源紧张状态下输血时机对儿童输血效果及临床预后的影响。方法 本回顾性队列研究纳入2020年1月—2020年12月在广州市妇女儿童医疗中心儿科急诊就诊并申请输血的患儿的临床预后。结果 共566例发起红细胞和血小板的非手术输血申请的患儿纳入研究,包括 260 例的红细胞申请和306例血小板申请。260份红细胞申请中:209 例及时输血,40 例延时输血,11 例未输血;及时组和延时组的输血有效率分别为37.8%和35.0%(P=0.737);1名不良预后的死亡病例出现在及时组中,余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.886)。306份血小板申请中:195 例及时输血,108 例延时输血,3例未输血;1名不良预后的死亡病例出现在及时组中(0.51%),3名不良预后的死亡病例出现在延时组中(2.78%),余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.131)。结论 符合红细胞与血小板输血指征的非急诊手术用血的急诊患儿中,及时组、延时组和未输血组之间的临床结局没有差异。输血时机进一步需要大样本的循证研究加以确定。

Objective To investigate the influence of blood transfusion timing on blood transfusion efficacy and clinical prognosis in children under the strain of blood bank resources during COVID-19 pandemic. Methods This retrospective cohort study included clinical outcomes of pediatric emergency patients who applied for blood transfusion in Guangzhou Women and Children's Hospital from January 2020 to December 2020. Results A total of 566 children applicated blood transfusion for red blood cells and platelets for non-emergency surgical use were enrolled, including 260 red blood cells cases and 306 platelets cases. Among the 260 applications for red blood cells, 209 cases received timely transfusion, 40 cases received delayed transfusion, and 11 cases did not receive transfusion.The effective rate of transfusion for red blood cells was 37.8% in the timely group and 35.0% in the delayed group (P=0.737). One death case with poor prognosis was found in the timely transfusion group, and the clinical prognosis of the rest cases was good. There was no statistical difference in the clinical outcomes among the three groups (P=0.886). Among 306 applications for platelet, 195 cases had timely transfusion, 108 cases had delayed transfusion, and 13 cases did not had transfusion.One case with poor prognosis died in the timely transfusion group (0.51%), and three with poor prognosis died in the delayed transfusion group (2.78%). The rest of the cases had good clinical prognosis, and there was no statistical difference in clinical outcomes among the three groups (P=0.131). Conclusions There were no significant differences in clinical outcomes among the timely transfusion group, the delayed transfusion group, and the non-transfusion group for red blood cell and platelet transfusion respectively. The timing of transfusion may need to be determined by evidence-based studies with large samples.