烟台市临床输血现状调查分析

Investigation of clinical blood transfusion in Yantai City

目的调查2015-2016年烟台市临床输血现状,分析本市临床输血的薄弱环节,探讨加强临床输血管理的方法。方法选择2015-2016年62家与烟台市中心血站签署供血协议的医院为研究对象。根据各医院的等级和性质将其分为:三级综合性公立医院组(n=12)、二级综合性公立医院组(n=21)、妇幼保健院组(n=5)、一级综合性公立医院组(n=12)、非公立医院组(n=12)。其中,基层医院包括妇幼保健院、一级综合性公立医院及非公立医院。根据《烟台市医院输血质量评价考核表》,对62家医院的临床输血相关基础建设情况进行现场考核。采用填写调查问卷的方式,调查62家医院自体输血工作开展情况。随机抽取本研究62家医院于2016年1月至6月填写的临床输血申请单510份,以及临床输血病历270份,调查各级医院临床输血申请单和临床输血病历的合格率。各级医院的临床输血相关基础建设情况、自体输血开展率、临床输血申请单合格率、不同等级临床输血病历构成比等计数资料的5组间及二、三级综合性公立医院与基层医院间比较,采用χ2检验或者连续性校正χ2检验。结果①本研究烟台市62家医院中,建设临床输血相关信息化管理系统、与血站信息联网、单独设立输血科、参加室间质量评价,定期组织临床输血相关工作人员进行培训,以及采取有效措施对临床合理用血进行评价的医院比例分别为19.4%(12/62)、8.1%(5/62)、50.0%(31/62)、53.2%(33/62)、77.4%(48/62)和40.3%(25/62);二、三级综合性公立医院的上述6项指标均显著高于基层医院,并且差异亦均有统计学意义(χ^2=8.832,P=0.003;χ^2=4.779,P=0.029;χ^2=34.802,P<0.001;χ^2=34.030,P<0.001;χ^2=4.415,P=0.036;χ^2=15.936,P<0.001)。②本研究烟台市33家二、三级综合性公立医院的总自体输血开展率为51.5%(17/33),其中三级综合性公立医院组的自体输血开展率为83.3%(10/12);高于二级综合性公立医院组的33.3%(7/21),并且差异有统计学意义(χ^2=7.643,P=0.006)。③本研究62家医院的510份临床输血申请单的总合格率为82.7%(422/510);5组医院的"申请用血目的与申请血液成分功能相适应"检查项目合格率总体比较,差异有统计学意义(χ^2=31.141,P<0.001)。④本研究62家医院的270份临床输血病历的总合格率为70.0%(189/270)。5组医院的合格、部分合格、不合格临床输血病历构成比总体比较,差异有统计学意义(χ^2=66.221,P<0.001)。结论烟台市各级医院均存在不同程度的临床输血相关基础建设投入不足情况,基层医院的临床输血相关基础建设相对滞后。部分医院的自体输血工作及临床输血管理亦有待提高。基层医院临床输血管理亟待加强,主管部门应加强对医院的输血质量评价力度。

Objective To investigate the current status of clinical blood transfusion in Yantai City from 2015 to 2016, analyze the weak links of clinical blood transfusion, and explore ways to strengthen clinical blood transfusion management. Methods Form 2015 to 2016, a total of 62 hospitals that signed blood supply agreements with the Yantai Central Blood Central Station were selected as research objects. According to the levels and charactoristics of the 62 hospitals, they were divided into tertiary general and public hospital group (n=12), secondary general and public hospital group (n=21), maternal and child health hospital group (n=5), first-class general and public hospital group (n=12), and private hospital group (n=12). In this study, primary hospitals included maternal and child health hospitals, first-class general and public hospitals and private hospitals. According to the Hospital Blood Transfusion Quality Evaluation and Assessment Form in Yantai City, on-site assessment of the infrastructure related to clinical blood transfusion in 62 hospitals was conducted. The questionnaires were used to investigate the implementaton of autologous blood transfusion in the 62 hospitals. A total of 510 clinical blood transfusion application forms and 270 clinical blood transfusion records were sampled randomly from 62 hospitals in January to June 2016, and the qualification rates of clinical blood transfusion application forms and clinical transfusion records were investigated. The chi-square test or the continuous correction chi-square test was used to compare the differences among hospitals of different groups or levels, which included proportions of hospitals evaluated by indicators of infrastructure related to clinical blood transfusion, implementaton rates of autologous blood transfusion, qualification rates of clinical blood transfusion application forms, and the composition ratio of clinical blood transfusion records of different grades. Results ① Among the 62 hospitals of this study, the proportion of hospitals that built clinical blood transfusion-related information management systems was 19.4%(12/62), proportion of hospitals that connected information with blood stations by internet was 8.1%(5/62), proportion of hospitals with separate blood transfusion department was 50.0%(31/62), proportion of hospitals participating in inter-room quality evaluation was 53.2%(33/62), proportion of hospitals that regularly organized clinical blood transfusion-related staffs to train was 77.4%(48/62), proportion of hospitals that took effective measures to evaluate reasonable clinical blood was 40.3%(25/62). The above 6 indicators of the secondary and tertiary general and public hospitals were significantly higher than those of the primary hospitals, and the differences were statistically significant (χ^2=8.832, P=0.003;χ^2=4.779, P=0.029;χ^2=34.802, P<0.001;χ^2=34.030, P<0.001;χ^2=4.415, P=0.036;χ^2=15.936, P<0.001).② The total implementaton rate of autologous blood transfusion in 33 secondary and tertiary general and public hospitals in Yantai City was 51.5%(17/33). The implementaton rate of autologous blood transfusion in tertiary general and public hospital group was 83.3%(10/12), which was higher than that of 33.3%(7/21) in secondary general and public hospital group, and the difference was statistically significant (χ^2=7.643, P=0.006).③ In this study, the total qualified rate of 510 clinical blood transfusion application forms of the 62 hospitals was 82.7%(422/510). In evaluation of " Cosistency of applying for blood use and application of blood component function", the overall difference in the qualified rates among 5 groups was statistically significant (χ^2=31.141, P<0.001).④ In this study, the total qualified rate of 270 clinical transfusion records in the 62 hospitals was 70.0%(189/270). The overall difference in composition ratios of qualified, partially qualified, and unqualified clinical blood transfusion records in 5 groups was statistically significant (χ^2=66.221, P<0.001). Conclusions There is insufficient investment in clinical blood transfusion related infrastructure in hospitals at all levels in Yantai City, and the clinical blood transfusion related infrastructure of primary hospitals is relatively lagging behind. The autologous blood transfusion work and clinical blood transfusion management in some hospitals also need to be improved. The clinical blood transfusion management of some primary hospitals needs to be strengthened, and the competent authorities should strengthen the evaluation of the blood transfusion quality of these hospitals.