医院输血管理持续改进中的临床用血分析

Analysis of clinical blood use under continuous improvement of transfusion management in hospital

目的研究《医疗机构临床用血管理办法》配合本院推行的《医务人员不良执业行为记分管理办法》实施前后人均用血量、手术人均用血量、各种成分血人均用量及输血文书质量的变化，评价限制性输血措施的管理成效。方法回顾性分析本院2012年2月～2013年7月共4926份临床输血资料，按照国家卫生部第85号令《医疗机构临床用血管理办法》和本院执行的《医务人员不良执业行为记分管理办法》实施的先后顺序分为对照组、实验1组和实验2组，分别比较各组间人均用血量，手术人均用血量、各成分血用量及输血文书质量的差异性；分析全陡月出院人数、月手术人次等临床诊治指标与月用血总量的相关性。结果实验2组的人均用血量、手术人均用血量、人均红细胞用量明显低于实验1组和对照组（P〈0．O当），但人均血浆用量、人均血小板用量在3组间差异无统计学意义。月出院人数和月用血总量呈正相关，月手术人次和月用血总量未显示相关性。输血文书的规范性在3组间差异有统计学意义（P〈0．05），实验2组输血病历不合格率明显低于其他2组。结论施行输血管理办法后本院人均用血量、手术人均用血量和人均红细胞用量均明显降低，输血文书的质量明显提高，显示本院目前的临床输血管理措施很有成效。但血浆、冷沉淀、血小板的用量仍未得到控制，应加强相关方面的管理。

Objective To analyze the effect of administrative measures for restricted transfusion by comparing the amount of blood used per person,the amount of blood used per person in operation ,the amount of blood component used and the quality of transfusion record sheet before and after the implement of 〈 Regulation on clinical blood use in medical institutions 〉 and 〈 Scoring regulation on poor practice of medical staff 〉. Methods 4 500 medical records of patients who had received blood transfusions form February 2012 to July 2013 ,were divided into three groups according to the time of transfusion contrl group（ before the implement of regulations,manage group one and group two after the implement of regulations）. Evaluation indexes were： the amount of blood used per person, the amount of blood used per person in operation and the amount of blood component used per person. The association between the number of discharges per month ,the number of operations per month and the amount of blood used per moonth were analyzed. Results The amount of blood used per person,the amount of blood used per person in operation and the amount of rend blood cell used per person in management group two were significantly lower than those in the other two groups （ P 〈 0.05 ） while tha amount of plasma used per person and the amount of platelet used per person showed no significant differences. The number of discharges per month was positively associated with the amount of blood used per moonth while the number of operations per month was not associated with the amount of blood used per moonth. The quality of transfusion records were significantly different between three groups （ P 〈 0.05 ）. The unqualified rate of transfusion records in management group two was lower than the other two groups. Conclusion The amount of blood used per person,the amount of blood used per person in operation and the amount of rend blood cell used per person decreased significantly while the quality of transfusion record improved significantly after the implement of the regulations. The managment measures in our hospital are very effective. But we should strengthen the management of platelet, plasma and cryoprecipitatc.