宜昌市临床用血现状调查分析
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摘要
目的了解宜昌地区医疗机构临床用血现状,为促进科学、合理用血提供依据。方法对宜昌市14家二级以上用血量较大的医院,每家医院抽查输血申请单100份,每家医院随机抽取20-25份有输血治疗的病历共305份,依据《临床输血技术规范》和《医疗机构临床用血管理办法》中的相关要求对输血病历进行输血合理性评价分析。结果 1 400份输血申请单中20%申请目的不正确,更有少部分血液成分名称不规范。305份病历中,51.8%的病历中医师作出了规范的临床输血适应性评价,37.70%病历中医师实施了临床输血有效性评价,15.73%为少量输血,红细胞输注不合理为25.1%,血浆不合理率为58.6%,血小板不合理率为10.8%。结论部分医师对血液成分的名称及其适应症未能正确掌握,用血前评估及输血后疗效评价未能引起医师足够重视;不合理输血现象在本地区部分医院普遍存在,且以手术科室明显,红细胞不合理输注主要表现为少量输血和输注指征偏宽,血浆主要表现为补充白蛋白及搭配输血。
Objective To understand the status of blood transfusion and to promote scientific and rational use of blood in the medical institutions of Yichang City. Methods 100 blood transfusion applications and 20-25 blood transfusion medical records were randomly selected from each hospital( a total of 1 400 copies of applications and 305 medical records) which belonged to 14 secondary level hospitals in Yichang City. The rationality of the blood transfusion medical records was analyzed and evaluated according to the relevant requirements from The Specification for Clinical Transfusion Technology and The Medical Institutions Clinical Blood Management Method. Results There are 20% applications which did not have the correct purpose and there were even a few applications which used incorrect blood component names among the 1 400 blood transfusion applications. There were 51. 8% medical records in which doctors made the standard and appropriate evaluations and 37. 7% medical records in which doctors made effectiveness evaluations for clinical blood transfusions among the 305 medical records. There were 15. 73% medical records for transfusion of small volume of blood. Among unreasonable requests,there were 25. 1% red cell transfusions,58. 6% plasma transfusions and 10. 8% platelet transfusions. Conclusion Some doctors fail to understand the names and indications of the blood components. Not enough attention was paid to the appropriateness of the evaluation before blood transfusion and the effectiveness of the evaluation after blood transfusion. Unreasonable blood transfusions are common in some hospitals in Yichang City,especially in the surgical departments. Unreasonable RBC transfusion mainly come from blood transfusion of small volume and wide general transfusion indications. Unreasonable plasma transfusions can be attributable to mainly consumption of supplementary albumin and crossmatch transfusion.
Objective To understand the status of blood transfusion and to promote scientific and rational use of blood in the medical institutions of Yichang City. Methods 100 blood transfusion applications and 20-25 blood transfusion medical records were randomly selected from each hospital( a total of 1 400 copies of applications and 305 medical records) which belonged to 14 secondary level hospitals in Yichang City. The rationality of the blood transfusion medical records was analyzed and evaluated according to the relevant requirements from The Specification for Clinical Transfusion Technology and The Medical Institutions Clinical Blood Management Method. Results There are 20% applications which did not have the correct purpose and there were even a few applications which used incorrect blood component names among the 1 400 blood transfusion applications. There were 51. 8% medical records in which doctors made the standard and appropriate evaluations and 37. 7% medical records in which doctors made effectiveness evaluations for clinical blood transfusions among the 305 medical records. There were 15. 73% medical records for transfusion of small volume of blood. Among unreasonable requests,there were 25. 1% red cell transfusions,58. 6% plasma transfusions and 10. 8% platelet transfusions. Conclusion Some doctors fail to understand the names and indications of the blood components. Not enough attention was paid to the appropriateness of the evaluation before blood transfusion and the effectiveness of the evaluation after blood transfusion. Unreasonable blood transfusions are common in some hospitals in Yichang City,especially in the surgical departments. Unreasonable RBC transfusion mainly come from blood transfusion of small volume and wide general transfusion indications. Unreasonable plasma transfusions can be attributable to mainly consumption of supplementary albumin and crossmatch transfusion.
引文
[1]中华人民共和国卫生部.临床输血技术规范.2000-06-01.
[2]中华人民共和国卫生部.医疗机构临床用血管理办法.2012-08-01.
[3]杨宝成,孔令魁,邵超鹏,等.2597份临床输血病历用血合理性调查分析.中国输血杂志,2008,21(3):193-196.
[4]张正芳.1647份临床输血病历用血合理性调查分析.中国输血杂志,2012,25(11):1187-1189.
[5]临床输血规范流程协作组.临床输血适应性与有效性评价流程.中国输血杂志,2013,26(6):587-589.
[6]黄建云,魏亚明,胡永红,等.输血申请与输血病历评估体系建立及其用于临床合理用血评价探讨.中国输血杂志,2012,21(10):1059-1062.
[7]朱晶沐,单来友,江淑芳.输血前评估对临床合理用血的价值.齐鲁医学杂志,2015,30(12):742-744.
[8]褚晓凌,黄锦红,刘丽霞,等.福州地区输血现状调查.中国输血杂志,2008,21(5):336-338.
[9]Cote C,Maclead JB,Yip A,et al.Variation in transfusion rates within a single institution:Exploring the effect of differing practice patterns on the likelihood of blood product transfusion in patients undergoing cardiac surgery.J Thoracic and Cardiovascula,2015,149(1):297-302.
[10]许靖,许忆新,吴小梅.发生不合理输血的原因探讨及促进合理用血的对策.中国输血杂志,2015,28(5):286-289.
[2]中华人民共和国卫生部.医疗机构临床用血管理办法.2012-08-01.
[3]杨宝成,孔令魁,邵超鹏,等.2597份临床输血病历用血合理性调查分析.中国输血杂志,2008,21(3):193-196.
[4]张正芳.1647份临床输血病历用血合理性调查分析.中国输血杂志,2012,25(11):1187-1189.
[5]临床输血规范流程协作组.临床输血适应性与有效性评价流程.中国输血杂志,2013,26(6):587-589.
[6]黄建云,魏亚明,胡永红,等.输血申请与输血病历评估体系建立及其用于临床合理用血评价探讨.中国输血杂志,2012,21(10):1059-1062.
[7]朱晶沐,单来友,江淑芳.输血前评估对临床合理用血的价值.齐鲁医学杂志,2015,30(12):742-744.
[8]褚晓凌,黄锦红,刘丽霞,等.福州地区输血现状调查.中国输血杂志,2008,21(5):336-338.
[9]Cote C,Maclead JB,Yip A,et al.Variation in transfusion rates within a single institution:Exploring the effect of differing practice patterns on the likelihood of blood product transfusion in patients undergoing cardiac surgery.J Thoracic and Cardiovascula,2015,149(1):297-302.
[10]许靖,许忆新,吴小梅.发生不合理输血的原因探讨及促进合理用血的对策.中国输血杂志,2015,28(5):286-289.