基于电子病历系统辨识输血不良反应的筛检策略研究

发布时间：2018-06-24 19:10

本文选题：输血不良反应 + 电子病历　；参考：《南方医科大学》2017年硕士论文

【摘要】：背景输血不良反应是输血过程中最常见的不良事件。尽管多数输血不良反应症状轻微,但仍可能导致患者医疗费用增加或就诊时间延长,对患者自身、家庭和社会造成负担;而且在极少数情况下,输血不良反应会导致患者发生严重的并发症甚至死亡。因此,对输血不良反应的监测受到高度重视。然而,由于医院中输血病例较多,如果对每一例输血病例都进行不良事件鉴定,对任何大型综合医院都不具有可操作性,因为这需要额外配备较多的专业人员。目前,关于输血不良反应的鉴定是在输血病例的主管医师上报的案例中展开的,由于各科室主管医师的输血专业知识所限或因业务繁忙而疏漏,难免出现误报和漏报现象,从而导致输血不良反应的数据失真。鉴于此,本研究将利用医院的电子病例系统,通过对既往输血病例资料的分析,试图剥离出能够客观反映输血不良反应的特征变量,并以此为关键筛检词,经逻辑判断,筛选出潜在输血不良反应病例,交由输血不良反应鉴定专家委员会确认。这样既可以大大减轻输血不良反应鉴定专家委员会的工作量,又可以极大程度上减少漏报的可能,从而使输血不良反应的监测既能显著提高准确性,又具有现实可操作性。目的提出一套基于医院电子病历系统的筛查策略用于筛检输血不良事件,以显著提高输血不良反应监测的准确性和现实可操作性。研究对象以南方医院2014年1月1日一2016年05月31日的所有住院输血患者为研究对象,剔除重要信息不完整的病例。方法根据患者就诊号和血液输注信息确定输血事件,运用开发工具PowerBuilder9.0,通过结构化查询语言SQL,以输血不良反应症状关键词为条件,在Orcal数据库中查询电子病历系统的护理记录和三测表记录,筛检记录中输血相关原始数据,如筛检结果不为空,初步判断潜在输血不良事件。再筛检对应输血前、后监测期的相关描述,结合三个时间的筛检结果,根据体征筛检潜在的输血不良事件原则缩小潜在输血不良事件范围。在此基础上搜索医生干预措施,根据搜索结果给予筛检潜在输血不良事件,并将筛检结果反馈给不良反应鉴定专家委员会。不良反应鉴定专家委员会针对潜在的输血不良事件,结合患者的病程记录、医嘱及相关检验检查等信息确认输血不良反应。按输血人次、输血事件、输血袋次和输血剂量四种计量单位计算输血反应率,与临床上报的输血不良反应率做比较。结果临床上报的输血不良反应率和通过筛检电子病历辨识确认输血不良反应率相比,差异有统计学意义(P0.001)。结论提出一种筛查输血不良反应的新方法一—通过筛检电子病历辨识输血不良反应。
[Abstract]:Background adverse reactions of blood transfusion are the most common adverse events in the course of blood transfusion. Although the symptoms of most transfusions are mild, they can lead to increased medical costs or prolonged visits, placing a burden on the patients themselves, their families and society, and in very few cases, Adverse reactions to blood transfusion can lead to serious complications and even death. Therefore, the monitoring of adverse reactions to blood transfusion is highly valued. However, because of the large number of blood transfusion cases in hospitals, it is not feasible for any large general hospital if each transfusion case is identified, because it requires more professional personnel. At present, the identification of adverse reactions of blood transfusion is carried out in the cases reported by the doctors in charge of blood transfusion cases. Due to the limitation of the professional knowledge of blood transfusion of the doctors in charge of each department or the omission of the professional knowledge of the doctors in charge of blood transfusion, it is inevitable that there will be misinformation and underreporting. This results in distortion of data on adverse reactions to blood transfusions. In view of this, this study will use the electronic case system of the hospital, through the analysis of the past blood transfusion case data, try to separate out the characteristic variable which can objectively reflect the adverse reaction of blood transfusion, and take this as the key screening word, through the logic judgment, Potential adverse reaction cases of blood transfusion were screened and confirmed by the expert Committee on the Identification of adverse reactions of Blood Transfusion. In this way, the workload of the expert committee on blood transfusion adverse reaction identification can be greatly reduced, and the possibility of underreporting can be greatly reduced. Thus, the monitoring of transfusion adverse reaction can improve the accuracy significantly and have practical maneuverability. Objective to propose a screening strategy based on hospital electronic medical record system for screening transfusion adverse events, so as to improve the accuracy and practicability of blood transfusion adverse reaction monitoring. The subjects of the study were all inpatients with blood transfusion from January 1, 2014 to May 31, 2016 in Southern Hospital. Methods Blood transfusion events were determined according to the patient's visit number and blood transfusion information. Using PowerBuilder 9.0and SQL as a structured query language, the key words of adverse reaction of blood transfusion were used as the condition. The nursing records and three table records of electronic medical record system were queried in Orcal database. The original data related to blood transfusion were screened. If the screening results were not empty, the potential adverse events of blood transfusion were preliminarily judged. The relevant description of the monitoring period before and after blood transfusion and the results of screening for three times were used to reduce the scope of potential adverse events according to the principle of screening for potential adverse events of blood transfusion according to the principle of physical sign screening. On this basis, the doctor intervention measures were searched, and the potential transfusion adverse events were screened according to the search results, and the screening results were fed back to the adverse reaction appraisal expert committee. The expert Committee on adverse reactions (ADRs) confirms the adverse events of blood transfusions according to the patient's history record, doctor's advice and relevant examination information for the potential adverse events of blood transfusion. The blood transfusion reaction rate was calculated according to the four units of blood transfusion, blood transfusion events, transfusion bag times and transfusion dose, and compared with the reported adverse reaction rate of blood transfusion. Results there was significant difference between the rate of blood transfusion adverse reactions reported in clinic and the rate of blood transfusion adverse reactions confirmed by the identification of electronic medical records (P0.001). Conclusion A new method for screening adverse reactions of blood transfusion is proposed.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R457.1;R197.3

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