输血申请单与取血处方在临床用血中的协同管理

发布时间：2018-06-13 14:33

本文选题：临床用血 + 输血申请单　；参考：《中国输血杂志》2016年03期

【摘要】：目的探讨输血申请单与取血处方在临床用血管理中的协同作用。方法分别从医院信息系统(HIS)、实验室信息系统(LIS)、输血信息系统(TIS)收集南方医院2013年9月-2014年12月的所有输血资料,包括患者信息、申请信息、处方信息、发血信息,统计分析4种血液成分和储存式自体全血在有关输注适应证和输血目的中的使用情况,以及输血前评估1(患者重要器官功能评估分级与高血压分级等5项)、输血前评估2(患者是否自体输血、出血、贫血、严重感染、使用相关药物等6项)、输血前评估3(患者当前生命体征、失血量及其他症状与特别要求等8项)内容填写情况。结果 8 487(人)次输血病例共已发血的申请单43 105份、处方分45 617份,有效发放血液49071次共82 837袋。按取血处方的输血适证分组统计,其中输注红细胞以急性失血、慢性贫血及围术期为主要输注适应证,三者输血量占到总输血量87.98%(43 949.0 U/49 954.5 U),这3类患者输注红细胞前Hb有明显差异(P0.01);输注血浆类以急性失血、凝血功能障碍及围术期为主要输注适应证,三者输血量占到总输血量66.91%(34085.5 U/50 941.5 U);输注机采血小板以预防性输注、出血/DIC及急性失血为主要输注适应证,三者输血量占到总输血量77.15%(8 556.0个治疗剂量/11 090.5个治疗剂量),这3类患者输注血小板前Plt,除出血/DIC和预防性输注无明显差异(P0.05)外,其余组间有明显差异(P0.01);输注冷沉淀以急性失血、凝血功能障碍及出血/DIC为主要输注适应证,三者输血量占到总输血量75.06%(4 788.0 U/6 378.5 U);输注储存式自体全血以围术期、预防性输注、急性失血为输注适应证,总输注量216.5 U。按输血申请单的4个输血目的(慢性贫血、急性失血、围术期、其他治疗)分组统计,其中输注红细胞前患者Hb值除慢性贫血和急性失血无明显差异(P0.05)外,其余组间有明显差异(P0.01);输注机采血小板前患者Plt除慢性贫血和其他治疗无明显差异(P0.05)外,其余组间存在明显差异(P0.05)。输血前评估2全部选"否"的取血处方占57.76%(2 635份/45 617份),而全部选"是"的占0.29%(131份/45 617份);输血前评估1的5项均未填写的申请单占87.33%(37 644份/43 105份),输血前评估3的8项均未填写的取血处方占87.77%(40 040份/45 617份)。结论取血处方纳入TIS,为临床输血适应性评估及输血有效性评价提供了数据支持。
[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.
【作者单位】：南方医科大学南方医院输血科;南方医科大学南方医院信息科;
【分类号】：R457.1

【相似文献】