某医院72例大量输血病例回顾性分析

Retrospective analysis of 72 cases of massive blood transfusion

目的了解医院临床大量输血现状,进一步提高临床科学、合理和安全用血水平。方法调阅2016年大量输血病历,按照相关标准对临床用血情况进行回顾性统计分析。结果全年有大量输血病例72例,其中72例输注红细胞悬液,总输注量995.5 U,平均13.8 U/例;69例输注新鲜冰冻血浆,总输注量100 670 mL,平均1 398.2 mL/例;43例输注冷沉淀,总输注量713.4 U,平均9.9 U/例;26例输注单采血小板,总输注量41治疗量,平均0.6治疗量/例。大量输血病例分布于12个科室,排在前3位的分别是心血管外科占45.83%、肝胆外科占12.5%、胃肠外科占8.34%。按疾病分类,排在前几位的分别是肿瘤、主动脉夹层、肝脾破裂、消化道出血等。术前凝血功能异常患者数占总数的65.28%,贫血者占总数的37.5%。发生死亡19例,死亡率为26.4%,死亡数较高的病例主要以心血管外科、肝胆外科为主。结论大量输血时各成分的合理搭配使用存在较大的问题,大部分科室成分血合理输注指证与时机掌握的普遍不好,存在大量输血时冷沉淀和血小板使用不及时、使用量不够、"搭配血"中血小板和冷沉淀适应症合理性输注比率低;存在经验性、习惯性用血;围术期术前贫血及凝血功能异常未得到及时的纠正。

Objective To evaluate the current situation of clinical massive blood transfusion in hospitals in an effort to develop scientific,rational and safe clinical blood application strategies. Methods Massive blood transfusion cases of 2016 were collected from data base of the subject hospital. The data were retrospectively analyzed according to related regulations.Results A total of 72 cases of massive blood transfusion were processed. 72 cases performed red blood cells transfusion with a total infusion quantity of 995. 5 U at 13. 8 U per case; 69 cases received fresh frozen plasma with a total infusion volume of 100 670 mL at 1 398. 2 mL/case; 43 cases adopted cold precipitation with a total infusion volume of 713. 4 U at 9. 9 U per case; 26 cases were treated with single platelet transfusion with a total infusion volume of 41 treatment units at 0. 6 treatment units per case. These cases sourced from 12 departments in the hospital with the top 3 being the cardiovascular surgery department（ 45. 83%）,the department of hepatobiliary surgery（ 12. 5%） and the gastrointestinal surgery department（ 8. 34%）. Disease-wise,tumor,aortic dissection,liver/spleen rupture and gastrointestinal bleeding were the top blood-consuming diseases. Patients with abnormal coagulation pre-operation accounted for 65. 28% of the total patient volume while anemia accounted for 37. 5% of the total volume. Death occurred in 19 cases with a mortality rate of 26. 4%. The fatal cases mainly sourced from the cardiovascular surgery department and the department of hepatobiliary surgery. Conclusion It appears that departments involved in this research had difficulties in designing proper component combinations when it comes to massive blood transfusion. Most of the departments failed to identify valid proof and evidence for transfusion strategies,which was usually accompanied by bad transfusion timing as well. As for the application of cold precipitation and platelets,timing and transfusion quantity strategies are crucial yet not very well performed by these departments. In addition,the ratio of platelet and cold precipitation in a＂mixed blood＂treatment often fails to meet the sensible treating range. The empirical,habitual use of blood also exhibits potential risks. Last but no least,perioperative anemia and coagulation abnormalities have not been coped with in time.