某院血液输注及时情况现状调查与对策

The research and the strategy on the present situation of timely blood transfusion in one hospital

目的通过对本院输注去白细胞红细胞悬液的患者输血及时性与每袋血液输注时间的调查,提高输血护理的质量及输血安全水平。方法随机抽取本院780名输注去白细胞红细胞悬液患者病案查阅输血护记,调查从血液接收至开始输注的时间及每袋血液从开始输注至输注结束的时间,分析影响血液输注及时性及每袋血液完成输注时间的因素。结果 780例输血患者中,血液接收至开始输注时间在30 min内的占696例(89.2%),30 min后输注的占84例(10.8%)。血液延迟输注因素主要是患者发热的占29例(34.5%);同时间输血患者太多的占25例(29.8%);患者在接受其他检查、治疗的占18例(21.4%);护士安排不合理的占12例(14.3%)。每袋血4 h内输完的占726例(93.1%),超过4 h输完的占54例(6.9%)。导致血液输注时间超过4 h的因素主要是患者发热17例(31.5%);心、肺功能不全14例(25.9%);高龄、体质弱12例(22.2%);输血器堵塞5例(9.3%);静脉通道不畅4例(7.4%);出现过敏反应2例(3.7%)。结论通过全院输血护理知识培训提高护士对输血护理的执行力,输血科加强对到达用血科室血液的管控,确保离库血液及时输注并在4 h内输注完毕,提高安全输血水平。

Objective To investigate the timely manner of blood transfusion in patients whose erythrocyte suspension underwent leukocyte depletion, to explore the time of transfusion in every blood bag, and to enhance the quality of transfusion care and the level of the transfusion safety. Methods 780 transfusion cases with leukocyte depletion in erythrocyte suspension in nursing records were randomly selected in this hospital. The time from the receipt of blood to the beginning of transfusion and the time of transfusion were collected. Lastly, the influence of timely blood transfusion and the transfusion time of every blood bag were analyzed. Results Among the 780 patients with transfusion, there were 696 cases （89.2%） whose time from receipt of blood to the act of transfusion was within half an hour and 84 cases （ 10.8% ） transfused after half an hour. There were 29 cases （34.5%） in which the major factor for delayed transfusion was the onset of fever, 25 cases （29. 8% ） received too much transfusion simultaneously, 18 cases （21.4%） received other medical examination or treatments, and 12 cases （ 14.3% ） delayed transfusion due to unreasonable arrangements by nurses. There were 726 cases （93.1%） that transfused one blood bag within 4 hours and 54 cases （6.9%） spent more than 4 hours. The main factors leading to more than four hours of transfusion time were the following： fever in 17 cases （31.5%）, cardiopulmonary insufficiency in 14 cases （25.9%）, advanced age or weakened immune system in 12 cases （22.2%）, obstruction of the transfusion apparatus in 5 cases （9.3%）, obstructed vein in 4 cases （7.4%）, and anaphylaxis in 2 cases （3.7%）. Conclusion Provision of training on transfusion care can enhance the nurses＇ execution ability in transfusion. The depamnent of blood transfusion can then strengthen the management of the use of blood by other clinical departments. Also, it can insure that the blood can be transfused in time and finished within 4 hours, and thus, enhance the level of transfusion safety.