新生儿输血热点调查
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摘要
目的:调查我国新生儿输血热点问题,为进一步研究新生儿输血达成专家共识提供依据。方法:采用现场问卷调查和头脑风暴法,对参与中国新生儿输血多中心队列研究项目启动会的101人,按照不同医师执业类型设计新生儿科医生问卷和输血科医生问卷,进行现场问卷调查。结果:①调查对象基本情况博士及硕士分别占比11.9%及55.4%;正高职称及副高职称分别占比18.0%及50.8%。②新生儿科医生对体重1 000 g以下新生儿红细胞输注阈值不同职称医师选择差异有统计学意义(P<0.05);体重1 000～1 499 g及1 500～2 499 g新生儿红细胞输注阈值不同职称之间选择差异无统计学意义(P>0.05)。③新生儿科医生对新生儿输血后症状体征改善指标排序为:肤色-呼吸-心率-胃肠-代谢-神志-黄疸-体温。④仅有20%医生关注医源性失血,不同职称医生关注程度差异无统计学意义(P>0.05)。⑤86.9%的输血科医生采用正反定型鉴定新生儿ABO血型,仅有13.1%采用正定型鉴定血型;68.9%输血科医生认为新生儿交叉配血标本应采用3 d以内的血液标本;血小板制品选择方面有85.2%的医院选择机采血小板。结论:在我国临床医生对于新生儿输血指征多依靠个人经验,无统一的规范及标准,在医源性失血问题上关注程度低;输血科医生在实验室检测方法学及血制品选择上仍存在差异,本研究结果为制定我国新生儿输血专家共识提供重要的数据支撑。
Objective:To investigate the hotpots issues of neonatal blood transfusion in China,and provide the basis for further study of neonatal blood transfusion. Method:Using the on-site questionnaire and brainstorming method,101 people who participated in the launch meeting of the Chinese neonatal blood transfusion multi-center cohort study project designed a Neonatologist questionnaire and a blood transfusion doctor questionnaire according to different types of physician practice,and conducted on-site questionnaire. Result:① The basic situation of the respondents was that doctors and masters accounted for 11.9% and 55.4% respectively;senior positions and vice-high-level titles accounted for 18.0% and 50.8% respectively.② Neonatologists with different physician titles had statistically significant choices for neonatal red blood cell infusion thresholds below 1 000 g(P<0.05),and had not statistically significant choices for neonatal red blood cell infusion thresholds between 1 000-1 499 g and 1 500-2 499 g(P>0.05).③ Neonatologists ranked the indicators of improvement in symptoms and signs after neonatal transfusion which were skin color-respiratory-heart rate-gastrointestinal-metabolism-consciousness-jaundice-temperature.④Only 20% of doctors paid attention to iatrogenic blood loss,and there were no noticeable differences in the degree of attention of doctors with different titles(P>0.05).⑤86.9% of blood transfusion doctors used positive and negative typing to identify neonatal ABO blood type,13.1% only used positive type to identify blood type;68.9% of transfusion doctors believed that neonatal cross-matching blood samples should use blood samples within 3 days;85.2% of hospital chose to apheresis platelets products.Conclusion:The treatment decisions of neonatal blood transfusion by doctors were often still based on clinical experience,and the recommendations were inconsistent.And there was little concern about iatrogenic hemorrhage.There were differences in choosing laboratory method and selection of blood products for doctors of blood transfusion department.This study can provide important data to support for the development of consensus on neonatal transfusion experts in China.
Objective:To investigate the hotpots issues of neonatal blood transfusion in China,and provide the basis for further study of neonatal blood transfusion. Method:Using the on-site questionnaire and brainstorming method,101 people who participated in the launch meeting of the Chinese neonatal blood transfusion multi-center cohort study project designed a Neonatologist questionnaire and a blood transfusion doctor questionnaire according to different types of physician practice,and conducted on-site questionnaire. Result:① The basic situation of the respondents was that doctors and masters accounted for 11.9% and 55.4% respectively;senior positions and vice-high-level titles accounted for 18.0% and 50.8% respectively.② Neonatologists with different physician titles had statistically significant choices for neonatal red blood cell infusion thresholds below 1 000 g(P<0.05),and had not statistically significant choices for neonatal red blood cell infusion thresholds between 1 000-1 499 g and 1 500-2 499 g(P>0.05).③ Neonatologists ranked the indicators of improvement in symptoms and signs after neonatal transfusion which were skin color-respiratory-heart rate-gastrointestinal-metabolism-consciousness-jaundice-temperature.④Only 20% of doctors paid attention to iatrogenic blood loss,and there were no noticeable differences in the degree of attention of doctors with different titles(P>0.05).⑤86.9% of blood transfusion doctors used positive and negative typing to identify neonatal ABO blood type,13.1% only used positive type to identify blood type;68.9% of transfusion doctors believed that neonatal cross-matching blood samples should use blood samples within 3 days;85.2% of hospital chose to apheresis platelets products.Conclusion:The treatment decisions of neonatal blood transfusion by doctors were often still based on clinical experience,and the recommendations were inconsistent.And there was little concern about iatrogenic hemorrhage.There were differences in choosing laboratory method and selection of blood products for doctors of blood transfusion department.This study can provide important data to support for the development of consensus on neonatal transfusion experts in China.
引文
[1] Strauss.RBC transfusion and/or recombinant EPO therapy of the anaemia of prematurity[J].Isbt Science,2010,1:11-14.
[2] English AI.Red blood cell transfusions in newborn infants:Revised guidelines[J].Paediatrics Child Health,2002,7:553-566.
[3] 李茂军,吴青,阳倩,等.新生儿输血治疗的管理:意大利新生儿输血循证建议简介[J].中华实用儿科临床杂志,2017,32(14):1063-1066.
[4] 全怡,陶岚,姜琳.戴明循环管理法联合头脑风暴法在消化内镜治疗中对护理配合度及不良事件的影响[J].中国医学装备,2017,14(12):123-126.
[5] 水志国.头脑风暴法简介[J].学位与研究生教育,2003,20(1):44-44.
[6] Strauss RG.Anaemia of prematurity:Pathophysiology and treatment[J].Blood Rev,2010,24:221-225.
[7] 李姣,杨晓燕,石晶,等.基于共词分析法分析我国新生儿输血的研究现状[J].中华妇幼临床医学杂志(电子版),2018,14(1):38-43.
[8] 庄静文,刘思征,马廉.新生儿贫血及输血[J].中华实用儿科临床杂志,2018,33(3):176-180.
[9] 彭华,童笑梅.医源性失血与早产儿贫血的发生及需要输血的相关性研究[J].中华新生儿科杂志,2008,23(4):197-200.
[10] Widness JA.Pathophysiology of Anemia During the Neonatal Period,Including Anemia of Prematurity[J].Neoreviews,2008,9:e520.
[11] Jeon GW,Sin JB.Risk Factors of Transfusion in Anemia of Very Low Birth Weight Infants[J].Yonsei Med J,2013,54:366-373.
[12] Carroll PD,Widness JA.Nonpharmacological,Blood Conservation Techniques for Preventing Neonatal Anemia—Effective and Promising Strategies for Reducing Transfusion[J].Semin in Perinatol,2012,36:232-243.
[13] 苏颖,王华,姜瑞民.某医院新生儿中新鲜冷冻血浆输注情况调查与分析[J].人民军医,2012,60(9):838-839.
[2] English AI.Red blood cell transfusions in newborn infants:Revised guidelines[J].Paediatrics Child Health,2002,7:553-566.
[3] 李茂军,吴青,阳倩,等.新生儿输血治疗的管理:意大利新生儿输血循证建议简介[J].中华实用儿科临床杂志,2017,32(14):1063-1066.
[4] 全怡,陶岚,姜琳.戴明循环管理法联合头脑风暴法在消化内镜治疗中对护理配合度及不良事件的影响[J].中国医学装备,2017,14(12):123-126.
[5] 水志国.头脑风暴法简介[J].学位与研究生教育,2003,20(1):44-44.
[6] Strauss RG.Anaemia of prematurity:Pathophysiology and treatment[J].Blood Rev,2010,24:221-225.
[7] 李姣,杨晓燕,石晶,等.基于共词分析法分析我国新生儿输血的研究现状[J].中华妇幼临床医学杂志(电子版),2018,14(1):38-43.
[8] 庄静文,刘思征,马廉.新生儿贫血及输血[J].中华实用儿科临床杂志,2018,33(3):176-180.
[9] 彭华,童笑梅.医源性失血与早产儿贫血的发生及需要输血的相关性研究[J].中华新生儿科杂志,2008,23(4):197-200.
[10] Widness JA.Pathophysiology of Anemia During the Neonatal Period,Including Anemia of Prematurity[J].Neoreviews,2008,9:e520.
[11] Jeon GW,Sin JB.Risk Factors of Transfusion in Anemia of Very Low Birth Weight Infants[J].Yonsei Med J,2013,54:366-373.
[12] Carroll PD,Widness JA.Nonpharmacological,Blood Conservation Techniques for Preventing Neonatal Anemia—Effective and Promising Strategies for Reducing Transfusion[J].Semin in Perinatol,2012,36:232-243.
[13] 苏颖,王华,姜瑞民.某医院新生儿中新鲜冷冻血浆输注情况调查与分析[J].人民军医,2012,60(9):838-839.