《特殊紧急抢救输血推荐方案》应用实践

Application of the recommend scheme for blood transfusion of emergency rescue under special circumstances

目的分析《特殊情况紧急抢救输血推荐方案》(简称《紧急输血方案》)在医院紧急医疗抢救工作中实施的效果及意义。方法根据《紧急输血方案》的应用范围,从广州市第一人民医院2013-2015年46 061例输血病例中,收集《紧急输血方案》公布前后3年符合特殊情况紧急抢救输血的524例病例做回顾性总结分析和比较,包括《紧急输血方案》实施前后特殊情况紧急抢救输血的一般及变化情况、ABO及Rh血型同型输注与相容性输注比例、输血适应证种类、病例的临床科室分布、实验室检测处理时间以及输血不良反应发生率等。结果在《紧急输血方案》的指导下,完成374例特殊情况需要紧急抢救输血的临床输血病例,医院输血科及相关科室执行紧急特殊输血治疗的能力和时间效率都有很大提高,尤其是《紧急输血方案》公布前后处理ABO疑难血型患者紧急抢救输血病例的实验室处理时间(h)由1.37±0.21缩短至0.32±0.10(P<0.05)、库存不足导致需要不同型血液成分输注的实验室处理时间(h)由0.31±0.10缩短至0.22±0.10(P<0.05),并体现在RhD阴性血患者紧急抢救的病例中。结论《紧急输血方案》为输血科和临床科室提供了科学、规范、标准的输血急救治疗依据和指导,使得抢救输血能有效缓解患者病情和赢得治疗时间。

Objective The recommend scheme for blood transfusion of emergency rescue under special circumstances was published in 2014. A retrospective analysis of the recommend scheme showed its clinical efficiency and significance in routine blood transfusion. Methods 524 cases of emergency rescue under special circumstances in total 46061 cases of blood transfusion were analyzed and compared after conducting according to the recommend scheme. Results Ability and efficiency of blood transfusion department are improved in dealing with emergency transfusion under special circumstances when guided by the recommend scheme. The changes were indicated especially in the emergency rescue cases under unsure of ABO blood group,shortage of blood and RhD negative circumstances. The laboratory process time of emergency rescue cases of undetermined ABO typing shortened from（ 1. 37 ± 0. 21） h to（ 0. 32 ± 0. 10） h（ P〈0. 05）,the laboratory process time of emergency rescue cases with blood shortage reduced from（ 0. 31 ± 0. 10） h to（ 0. 22 ± 0. 10） h（ P〈0. 05）. Conclusion The recommend scheme provides a scientific and standard procedure for blood transfusion of emergency rescue under special circumstances,and shortens experiment duration for patients need blood transfusion.