Abstract: Objective A retrospective study was conducted to investigate the incidence of transfusion-related respiratory adverse reactions associated with massive blood transfusion for perioperative management of patients undergoing cardiac surgery. Methods Data of blood transfusion of 589 patients requiring massive perioperative transfusion in cardiac surgery from January 1,2018 to January 1,2022 were collected. The incidence of respiratory adverse reactions associated with blood transfusion was analyzed. According to severity,the patients were divided into two groups： the severe group and the non-severe group. The relationship between severity and the amount of blood transfusion 24 h before,during and after surgery was analyzed. Results 6.62%（39/589） cases had respiratory reactions within 24 hours of a blood transfusion. Of which,12 cases had transfusion-associated circulatory overload（TACO）,accounting for 30.77%; 27 cases had transfusion associated dyspnea （TAD）,accounting for 69.23%. 41.67%（5/12）of 12 TACO cases were associated with blood transfusion,as were 3（11.11%）of 27 TAD cases. The mortality rate of TACO was 16.67% higher than that of TAD 7.41%. The amount of red blood cells and plasma in the severe group were higher than that in the non-severe group. The difference between the intakes and outtakes in 24 h was higher than that in the non-severe group,with statistical significance （P<0.05）. The amount of perioperative transfusion in the severe group was higher than that in the non-severe group,with statistical significance（P<0.05）. The three patients identified as transfusion-related deaths were all female. They had blood transfusion history,pregnancy,and had at least 3 transfusions,of which 2 were TACO and 1 TAD. Conclusion The incidence and mortality of respiratory adverse reactions were high in patients requiring massive blood during perioperative period of cardiac surgery. It is suggested that options and amount of perioperative red blood cell and plasma should be refined. The perioperative respiratory system monitoring should be strengthened,and multidisciplinary treatment should be strengthened to focus on prevention, early detection and early treatment to improve the safety of blood transfusion.

Key words: Blood transfusion reaction, Transfusion-associated dyspnea, Cardiac surgery, Massive blood transfusion, Transfusion-associated circulatory overload