优化重症外科监护室术后患者用血结构的探索

Exploration of blood transfusion strategy optimization for postoperative patients in the department of surgery intensive care unit

目的探索输血科优化重症外科监护室对术后患者用血结构的实践。方法以重症外科监护室为试点,细化各血液成分的发放标准,以专人发血加强发血审核,每月抽查合理用血病历,对临床合理用血进行监管和指导,分析2015和2016年数据,比较加强监管前后用血结构的变化。结果与2015年比较,2016年重症外科监护室患者输血比例下降3.92%（P〈0.01）,用血总量、血浆用量占全院用量的比例分别下降1.9%（P〈0.01）和4.8%（P〈0.01）;红细胞和冷沉淀用量占全院用量的比例分别上升1.3%（P〈0.01）,2.4%（P〈0.01）;用血结构分析可见,普通冰冻血浆用量占该科室用血总量的比例下降21.6%（P〈0.01）,新鲜冰冻血浆、冷沉淀和红细胞用量占该科室用血总量的比例分别上升4.9%（P〈0.01）、8.7%（P〈0.01）和7.8%（P〈0.01）。结论输血科对临床用血监管和指导是行之有效的,可优化临床用血结构,提高血液合理使用率。

Objective To optimize blood transfusion strategy in the department of transfusion for postoperative patients in the department of surgery intensive care unit. Methods The new strategy was optimized with the department of surgery intensive care unit being the trail department. Personnel were specifically assigned for blood allocation with monthly check on blood transfusion records and thus achieving supervision and guidance for clinical blood use. We compared the data in 2015 and 2016 to evaluate the impact of the new strategy. Results Comparing to 2015,the total of blood consumption,the percentage plasma consumption in the whole hospital and the proportion of patients transfused in 2016 decreased by1. 9%（ P 0. 01）,4. 8%（ P〈0. 01）,3. 92%（ P〈0. 01）,respectively. The consumption of red blood cell and cryoprecipitate increased by 1. 3%（ P 0. 01）,2. 4%（ P〈0. 01）. Analysis of transfusion element composition showed that the use of normal frozen plasma decreased by 21. 6%（ P〈0. 01） while fresh frozen plasma,cryoprecipitate and red blood cell used increased by4. 9%（ P〈0. 01）,8. 7%（ P〈0. 01） and 7. 8%（ P〈0. 01） respectively. Conclusion the efficiency of clinical rational transfusion was increased and the use of blood was optimized. It is possible to achieve the clinical supervision and guidance of blood use by the department of transfusion.