本文選題：臨床用血 + 輸血申請(qǐng)單　； 參考：《中國(guó)輸血雜志》2016年03期

【摘要】：目的探討輸血申請(qǐng)單與取血處方在臨床用血管理中的協(xié)同作用。方法分別從醫(yī)院信息系統(tǒng)(HIS)、實(shí)驗(yàn)室信息系統(tǒng)(LIS)、輸血信息系統(tǒng)(TIS)收集南方醫(yī)院2013年9月-2014年12月的所有輸血資料,包括患者信息、申請(qǐng)信息、處方信息、發(fā)血信息,統(tǒng)計(jì)分析4種血液成分和儲(chǔ)存式自體全血在有關(guān)輸注適應(yīng)證和輸血目的中的使用情況,以及輸血前評(píng)估1(患者重要器官功能評(píng)估分級(jí)與高血壓分級(jí)等5項(xiàng))、輸血前評(píng)估2(患者是否自體輸血、出血、貧血、嚴(yán)重感染、使用相關(guān)藥物等6項(xiàng))、輸血前評(píng)估3(患者當(dāng)前生命體征、失血量及其他癥狀與特別要求等8項(xiàng))內(nèi)容填寫(xiě)情況。結(jié)果 8 487(人)次輸血病例共已發(fā)血的申請(qǐng)單43 105份、處方分45 617份,有效發(fā)放血液49071次共82 837袋。按取血處方的輸血適證分組統(tǒng)計(jì),其中輸注紅細(xì)胞以急性失血、慢性貧血及圍術(shù)期為主要輸注適應(yīng)證,三者輸血量占到總輸血量87.98%(43 949.0 U/49 954.5 U),這3類患者輸注紅細(xì)胞前Hb有明顯差異(P0.01);輸注血漿類以急性失血、凝血功能障礙及圍術(shù)期為主要輸注適應(yīng)證,三者輸血量占到總輸血量66.91%(34085.5 U/50 941.5 U);輸注機(jī)采血小板以預(yù)防性輸注、出血/DIC及急性失血為主要輸注適應(yīng)證,三者輸血量占到總輸血量77.15%(8 556.0個(gè)治療劑量/11 090.5個(gè)治療劑量),這3類患者輸注血小板前Plt,除出血/DIC和預(yù)防性輸注無(wú)明顯差異(P0.05)外,其余組間有明顯差異(P0.01);輸注冷沉淀以急性失血、凝血功能障礙及出血/DIC為主要輸注適應(yīng)證,三者輸血量占到總輸血量75.06%(4 788.0 U/6 378.5 U);輸注儲(chǔ)存式自體全血以圍術(shù)期、預(yù)防性輸注、急性失血為輸注適應(yīng)證,總輸注量216.5 U。按輸血申請(qǐng)單的4個(gè)輸血目的(慢性貧血、急性失血、圍術(shù)期、其他治療)分組統(tǒng)計(jì),其中輸注紅細(xì)胞前患者Hb值除慢性貧血和急性失血無(wú)明顯差異(P0.05)外,其余組間有明顯差異(P0.01);輸注機(jī)采血小板前患者Plt除慢性貧血和其他治療無(wú)明顯差異(P0.05)外,其余組間存在明顯差異(P0.05)。輸血前評(píng)估2全部選"否"的取血處方占57.76%(2 635份/45 617份),而全部選"是"的占0.29%(131份/45 617份);輸血前評(píng)估1的5項(xiàng)均未填寫(xiě)的申請(qǐng)單占87.33%(37 644份/43 105份),輸血前評(píng)估3的8項(xiàng)均未填寫(xiě)的取血處方占87.77%(40 040份/45 617份)。結(jié)論取血處方納入TIS,為臨床輸血適應(yīng)性評(píng)估及輸血有效性評(píng)價(jià)提供了數(shù)據(jù)支持。
[Abstract]:Objective to explore the synergistic effect of blood transfusion application sheet and blood collection prescription in clinical blood management. Methods all blood transfusion data, including patient information, application information, prescription information and blood transfusion information, were collected from hospital information system (HISS), laboratory information system (LISS) and blood transfusion information system (TISS) from September 2013 to December 2014, respectively. The use of four kinds of blood components and stored autologous whole blood in the indication of transfusion and the purpose of blood transfusion were analyzed statistically. And pre-transfusion assessment 1 (5 items such as critical organ function assessment grade and hypertension grade, etc.), and pre-transfusion assessment 2 (whether the patient has autologous blood transfusion, bleeding, anemia, severe infection, etc.) 6 items of related drugs were used, and 3 items (8 items of current vital signs, blood loss, other symptoms and special requirements) were evaluated before blood transfusion. Results there were 43,105 applications for blood transfusion with 45,617 prescriptions, and 82,837 bags of blood were effectively distributed 49071 times. According to the appropriate blood transfusion syndrome for blood transfusion, the main indications of erythrocyte transfusion were acute blood loss, chronic anemia and perioperative period. The blood volume of the three groups accounted for 87.98% of the total transfusion volume of 43 949.0 U / 49 954.5 U, there was significant difference in HB before erythrocyte transfusion among the three groups of patients, and the main indications of transfusion were acute blood loss, coagulation dysfunction and perioperative period. The volume of blood transfusions accounted for 66.91% of the total transfusion volume of 34085.5 U / 50 941.5 U. The main indications of transfusion machine were preventive transfusion, hemorrhage / DIC and acute blood loss. The volume of blood transfusion among the three groups accounted for 77.15% of the total amount of blood transfusion / 11,090.5 dose. Before platelets were infused into the three groups, there was significant difference between the other groups except bleeding / DIC and prophylactic infusion (P0.05), and the infusion of cryoprecipitation was associated with acute blood loss. Coagulant dysfunction and bleeding / DIC were the main indications of transfusion, the volume of blood transfusions accounted for 75.06% of the total blood transfusions (75.06U / 6 378.5 U), and the storage autogenous whole blood was infused with perioperative period, prophylactic infusion, acute loss of blood as the indication of transfusion, and the total transfusion volume was 216.5 U. According to the four blood transfusion purposes (chronic anemia, acute blood loss, perioperative period, other treatment), the HB value of the patients before erythrocyte transfusion was not significantly different except chronic anemia and acute blood loss (P 0.05). There was a significant difference between the other groups (P 0.01), except for chronic anemia and other treatments, there was a significant difference between the other groups (P 0.05). Pre-transfusion assessment 2 all the "no" blood collection prescriptions accounted for 57.7635 / 45,617, while all "yes" accounted for 0.291,131 / 45,617 applications; 5 applications for pre-transfusion assessment 1 were not filled out, 37,644 / 43,105 for pre-transfusion assessment, and 43,105 for pre-transfusion evaluation. 87.77777 / 45,617 / 45,617 / 45,040 / 45,617 / 45,040 / 45,617 / 87.77 / 45,617 / 45,617 / 45,@@ Conclusion taking blood prescription into TISprovides data support for clinical blood transfusion adaptability evaluation and blood transfusion effectiveness evaluation.
【作者單位】： 南方醫(yī)科大學(xué)南方醫(yī)院輸血科;南方醫(yī)科大學(xué)南方醫(yī)院信息科;
【分類號(hào)】：R457.1

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