输血不良反应智能路径构建与临床应用研究

Construction of intelligent path for adverse transfusion reactions and its clinical application

目的构建输血不良反应智能路径,探讨其在输血不良反应质量管理与输血安全预警中的应用价值。方法1)按照临床用血全面质量管理总体要求,在临床用血全程闭环智能路径管理与评价信息系统架构基础上,对输血不良反应工作流程实施智能路径化实时控制,以保障临床输血安全;2)对智能路径应用以来本院2013年-2015年6月21 284名出院输血患者做输血不良反应质量持续改进分析。结果 1)输血不良反应智能路径的构建,优化了输血不良反应工作流程,实现了临床输血过程监测的智能路径化实时控制与信息共享,有效提升了工作依从性、规范性,提高了临床用血工作效率和质量管理水平;2)本组出院输血患者中输血不良反应发生率为0.62%(132/21 284),其中红细胞、血浆输注的发生率(33.33%、45.45%)明显高于血小板、冷沉淀(18.94%、2.27%)(P<0.05);过敏反应发生率(81.82%)较非溶血性发热反应高(17.42%)(P<0.05);≥18岁病例的发生率(81.06%)高于<18岁病例(18.94%)(P<0.05),有输血史病例的发生率(62.12%)高于无输血史病例(37.88%)(P<0.05),而有、无妊娠史病例间差异甚小(P>0.05);输血不良反应绝大多数(90.15%)发生在输血过程<1 h,其中以输注30 min-1 h最多见(P<0.05)),占68.18%。结论输血不良反应智能路径的构建与应用实现了输血不良反应工作流程与质量控制的规范化、精细化、智能路径化,有效提高了临床用血质量管理水平和工作效率,能为临床用血质量持续改进和输血安全预警决策提供循证依据。

Objective To construct an intelligent path for adverse transfusion reaction,to explore the application value of adverse transfusion reaction quality management and blood transfusion safety alert. Methods 1） According to the general requirements of clinical blood transfusion quality management,the intelligent path and real-time control of blood transfusion adverse reaction workflow was carried out in order to ensure the safety of clinical blood transfusion on the basis of closed-loop intelligent path management and evaluation of information in clinical blood use. 2） Since the application of the intelligent path,the continuous improvement of adverse transfusion reactions quality was analyzed in 21 284 discharged patients in our hospital from 2013 to June 2015. Results 1） Adverse transfusion reactions workflow was optimized because of the construction of the intelligent path of adverse transfusion reactions,meanwhile,it could realize the intelligent path real-time control and information sharing of clinical blood transfusion monitoring process,and effectively improve the work efficiency and quality management level of clinical blood transfusion. 2） The incidence of adverse transfusion reactions was 0. 62%（ 132/21284） in 21 284 discharged patients who received blood transfusion in our hospital. The incidence rate of red blood cell and plasma transfusion（ 33. 33%,45. 45%） were significantly higher than that of platelets and cryoprecipitate（ 18. 94%,2. 27%）（ P〈0. 05）. The incidence of allergy（ 81. 82%） was higher than that of non-hemolytic febrile reaction（ 17. 42%）（ P〈0. 05）. Individuals 18-years-old with transfusion reaction（ 81. 06%） were statistically higher than those of 18-yearsold cases（ 18. 94%）. The incidence of transfusion history cases（ 62. 12%） was higher than that of zero transfusion history（ 37. 88%）（ P 0. 05）. There was no significant difference between cases with and without pregnancy history（ P〉0. 05）.The majority of adverse transfusion reactions occurred in 1 h（ 90. 15%） in the transfusion process,in which the time of infusion of 30min-1h was the highest（ P〈0. 05）,accounting for 68. 18%. Conclusion The construction and application of the intelligent path of adverse transfusion reaction have led to standardization,refinement and intelligent path of the work flow and quality control of the adverse transfusion reaction,which can effectively improve the level of quality management and work efficiency in clinical blood transfusion,and also provide evidence basis for the continuous improvement of clinical blood transfusion quality management and the early alert of transfusion safety.