南宁市重症地中海贫血患儿输血情况调查及针对性供血策略的建立

发布时间：2018-05-27 01:36

  本文选题：地中海贫血 + 输血治疗　； 参考：《中国输血杂志》2017年08期

【摘要】：目的了解南宁市需要定期输血的重症地中海贫血(简称地贫)患儿输血基本情况及与南宁周边城市的差异,逐步解决重症地贫患儿输血难的问题。方法问卷调查与病案调查相结合,自制调查问卷,调查内容包括重症地贫患儿基本情况(性别、地贫遗传史、户籍)、输血医疗费用情况(家庭月收入、医疗费用类型、输血自行承担费用)、输血情况(首次输血年龄、至今输血病程、输血次数、输血量)、血液供应情况(能否按期输血、能否足量输血)等,收集南宁市区[广西医科大学第一附属医院(简称广西医大一附院)地贫之家、解放军303医院(简称303医院)地贫之家](阶段性问卷调查,2013年11月-2014年1月),广西钦州市、河池市、百色市、来宾市、玉林市等5市(抽样问卷调查,2013年8月-2013年9月)以及南宁市辖武鸣、横县、宾阳、上林、马山、隆安6县(2008年11月-2013年10月回顾性问卷调查)共850份重症地贫患儿调查问卷,通过对调查数据的统计分析,制定并逐步实施南宁6县地贫患儿供血方案,依据该供血方案把握地贫患儿的供血情况及发展趋势。结果 1)南宁及其周边5市465名地贫患儿输血情况调查显示,6市地贫患儿在户籍构成比例、医疗费用类型、输血承担费用、输血病程、累计输血量、能否按期输血等方面人群分布率存在差异(P0.05)。2)广西医大一附院地贫之家及303医院地贫之家连续60 d 356份重症地贫患儿输血情况调查显示,2家地贫之家重症地贫患儿在家庭收入、累计输血量方面群分布率存在差异(P0.05)。3)2008年11月-2013年10月南宁市辖6县391例重症地贫患儿输血病案回顾性调查显示,6个县重症地贫患儿在首次输血年龄、输血病程、输血次数、累计输血量、能否按期输血、能否充足供血等方面人群分布率存在差异(P0.01)。4)建立了卫生行政部门领导,由地贫患儿、医疗机构、血站、无偿献血者构成的联动机制,优先解决南宁6县地贫患儿供血。各县指定地贫患儿定点输血医院,血站每月分3个时段向地贫患儿输血的医院供血,输血的地贫儿童基本资料登记备案,包括儿童基本信息、血型、输血频率及输血用量等;地贫患儿经治医师每次用血提前3 d向定点医院输血科申请,由定点医院输血科向血站供血科预约供血量,血站输血科审核通过后,按时将血液备齐由各定点输血医院按时领用。5)南宁市辖6县重症地贫患儿供血方案于2013年3月起逐步实施,截止2016年6月,各县重症地贫患儿用血量占比县全年用血量逐年升高(P0.01)。结论重症地贫患儿的规范输血宜施行属地化管理,做到唯一性编码登记在册,依据在册登记,开展统一重症地贫患儿基本情况及定期输血情况的基线调查,能够了解各地在一段时间内重症地贫患儿的输血治疗现状,预测其发展趋势,同时为血站保障重症地贫患儿的医疗用血提供依据。
[Abstract]:Objective to understand the basic situation of blood transfusion in children with severe thalassemia (thalassemia) who need regular blood transfusion in Nanning and the difference between them and the surrounding cities in Nanning, so as to solve the difficulty of blood transfusion in children with severe thalassemia. Methods A self-made questionnaire was made by combining the questionnaire survey with the medical record survey. The contents of the questionnaire included the basic situation of the children with severe thalassemia (sex, genetic history of thalassemia, household registration), medical expenses of blood transfusion (monthly income of family, type of medical expenses). Blood transfusions bear their own expenses, and blood transfusion (age of first transfusion, course of blood transfusion to date, number of blood transfusions, volume of blood transfusions), blood supply (whether blood can be transfused on schedule, whether blood can be given in sufficient quantities), etc. Nanning City [the first affiliated Hospital of Guangxi Medical University (referred to as the first affiliated Hospital of Guangxi Medical University) is a poor family, and the PLA 303 hospital (abbreviated as 303 hospital) is a poor family] (periodic questionnaire survey, November 2013-January 2014, Qinzhou City, Guangxi, China), Hechi City, Baise City, Laibin City, Yulin City and other cities (sampling questionnaire survey, August 2013-September 2013) and Wuming, Hengxian, Binyang, Shanglin, Ma Shan, Nanning City, A total of 850 questionnaires for children with severe thalassemia were collected in 6 counties (November 2008 to October 2013). Based on the statistical analysis of the survey data, a blood supply program for children with thalassemia in 6 counties of Nanning was formulated and implemented step by step. According to the blood supply program, the blood supply situation and development trend of children with thalassemia were grasped. Results 1) A survey of 465 children with thalassemia in Nanning and its surrounding cities showed that the proportion of household registration, the type of medical expenses, the cost of blood transfusion, the course of blood transfusion and the cumulative amount of blood transfusion were found in the children with thalassemia. There is a difference in the distribution rate of population in terms of blood transfusion on schedule (P0.05. 2) the investigation on the blood transfusion status of 356 children with severe thalassemia in Guangxi first affiliated Hospital and 303 Hospital for 60 days showed that there were 2 families with severe thalassemia in their family income. From November 2008 to October 2013, a retrospective investigation of 391 cases of severe thalassemia in Nanning City showed that the age of first blood transfusion, the course of blood transfusion and the number of times of transfusion were observed in the first transfusion age, the course of transfusion, and the number of blood transfusions in the children with severe thalassemia in 6 counties. There is a difference in the population distribution rate in terms of accumulative blood transfusion, regular blood transfusion and adequate blood supply. (P0.01k.4) has established a linkage mechanism composed of children with thalassemia, medical institutions, blood stations, and unpaid blood donors, under the leadership of the health administration department. Priority should be given to the blood supply of children with thalassemia in 6 counties of Nanning. The designated blood transfusion hospital for children with thalassemia in each county was divided into 3 times a month by blood station to supply blood to the hospital where children with thalassemia were given blood transfusion. The basic data of children with thalassemia were registered and recorded, including basic information of children, blood type, frequency of blood transfusion and dosage of blood transfusion. The child with thalassemia applied to the blood transfusion department of the designated hospital 3 days in advance for each time. The blood transfusion department of the designated hospital made an appointment to the blood supply department of the blood station, and the blood transfusion department of the blood station passed the examination and approval. The program of blood supply for children with severe thalassemia in 6 counties of Nanning City was gradually implemented in March 2013, and as of June 2016, The proportion of blood consumption in children with severe thalassemia increased year by year (P 0.01). Conclusion the standardized blood transfusion in children with severe thalassemia should be managed locally, and the registration of unique codes should be carried out. According to the registration, the baseline investigation on the basic situation and regular blood transfusion of children with severe thalassemia should be carried out. It can understand the current situation of blood transfusion treatment for children with severe thalassemia over a period of time, predict its development trend, and provide the basis for blood station to guarantee the medical use of blood for children with severe thalassemia.
【作者单位】： 南宁中心血站;
【基金】：广西壮族自治区卫生厅科研课题(Z2012667)
【分类号】：R556.61
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本文编号：1939845