杭州地区临床用血现状调查分析与思考

Investigation and analysis of blood transfusion in Hangzhou

目的了解杭州地区医疗机构临床用血管理现状。方法调研在杭州的14家三甲医院、5家三乙医院、5家二甲医院、4家二乙医院、7家未分类医院的输血科(血库)建设和临床输血管理情况,采用现场填写《医疗机构输血工作相关基本情况调查表》的方式,调查内容包括医院输血管理委员会的建立、输血科软硬件建设、输血信息系统的建立对接和使用等;现场考核输血科(血库)工作人员临床用血知识,并对反馈的《调查表》数据汇总和做统计分析。结果调研组专家现场填写《医疗机构输血工作相关基本情况调查表》100%(35/35)回收;在输血文书管理执行情况方面,各类(级)医疗机构没有明显的差别(P>0.05),患者输血前临床表现评估以三甲医院得分最高,输血后临床疗效评估以二甲医院得分最高,医生输血记录完整性以三乙医院得分最高;医护人员在临床用血知识考核情况得分,三甲医院、三乙医院以及二甲医院明显优于二乙医院和未评级医院(P<0.05);抽查的350份输血病历,考虑分析输血前后的实验室指标,病历有效率70.57%(247/350);各类医疗机构的内科、外科在输血指征(Hb指标)掌握上存在一定的差异。结论浙江省各级医院临床用血管理及输血科(血库)建设和管理尚需加强。尽快出台全省临床用血管理与输血科(血库)建设基本标准及考核细则,通过标准化、信息化建设以及输血专业知识的上岗培训,有助于实现临床用血管理的规范化。

Objective To analyze and evaluate the current progress of blood transfusion department establishment and clinical blood transfusion management in Hangzhou,China. Methods Questionnaires were sent to 35 medical institutions to gather information regarding blood transfusion department establishment and clinical blood transfusion management in the provincial, municipal and county tier hospitals. The investigated criteria covered the establishment of the hospital blood transfusion management committee, the utilization of software and hardware of the transfusion department, the compatibility status of various software systems in use and performance evaluation of these systems in clinical applications, etc. In addition, tests were also conducted on members of the blood transfusion departments to confirm whether they are properly trained and present adequated knowledge of clinical blood applications Results were then collected for statistical and descriptive analyses. Results The results out of the 35 hospitals surveyed presented no obvious statistical significance. Nevertheless, the average score of these hospitals in different segments helped us to reach the following conclusions ： 1, Tripte-A hospitals scored the highest av- erage score for patient clinical status evaluation pre-transfusion; 2. Double-B hospitals came first when it comes to patient clinical status evaluation post transfusion; 3. Triple-B hospitals possessed the most thorough clinical records for transfusion treatment.A total of 350 papers were issued and 350 papers were collected, with 327 out of the 350 considered valid. As for the test results regarding the departments members, triple-A, triple-B and double-A hospitals scored significantly higher than double-B and unranked hospitals. （P〈0. 05） ;.350 clinical transfusion records were also collected and 247 of which are considered valid. It appears there are numerous difference in Hb indexes among the tested hospitals and even the departments of internal medicine and surgical presented different takes on the subject as well. Conclusion The clinical blood transfusion management in Zhejiang province and the establishment of blood transfusion departments still need to be improved. A plan to manage clinical blood use need to be carried out ASAP, which would specify evaluation references, standardize personnel training and tech investments. Ultimately, we hope such actions would help to further regulate the clinical blood use in the region.