急诊失血手术患者使用改良围术期输血指征评分指导输血的安全性与可行性研究

Safety and feasibility of improved transfusion trigger score for emergency hemorrhage patients

目的探讨急诊失血手术患者使用改良围术期输血指征评分(POTTS-E)行个体化输血与凭借医师临床经验输血在临床合理用血的安全性与可行性。方法将2016年6月至2017年6月遵义医学院附属医院收治的急诊失血手术患者68例分为POTTS-E组和对照组,每组34例。POTTS-E组患者使用POTTS-E进行即时动态评价,依据评分决定选择输血的时机与输血量,对照组由管理患者的麻醉医生按照现行输血指南,依据自身临床经验判断安全与否,主观选择输血的时机与输血量。比较两组患者血红蛋白(Hb)水平、红细胞输注率、人均红细胞输注量、病死率、并发症发生率、一级护理时间、住院时间、输血费用及住院费用情况。结果POTTS-E组患者出手术室、术后24 h及出院时Hb均明显低于对照组(P<0.05);并发症发生率POTTS-E组明显低于对照组(20.69%vs.45.16%,P<0.05)。POTTS-E组红细胞输注率及人均红细胞输注量均少于对照组,但两组患者比较差异无统计学意义(P>0.05)。两组均无死亡病例;两组患者一级护理时间、住院时间、输血费用与住院费用比较,差异均无统计学意义(P>0.05)。结论使用POTTS-E指导临床个体化输血策略安全可行,并不增加并发症的发生率及病死率。

Objective To evaluate the safety and feasibility of improved transfusion trigger score for emergency hemorrhage patients(POTTS-E)and clinical experience of physicians guided individual blood transfusion strategy.Methods A total of 68 patients admitted to the Affiliated Hospital of Zunyi Medical College for emergency blood loss surgery from June 2016 to June 2017 were enrolled and divided into the POTTS-E group(n=34)and the control group(n=34).Time and amount for blood transfusion in the POTTS-E group was determined by immediate and dynamic POTTS-E score,which in the control group was subjectively determined by anesthesiologists in charge according to their clinical experience under the guidelines presented.Research contents including hemoglobin(Hb)level,amount and rate of blood transfusion,morbidity and mortality,first class nursing time,hospital stays,transfusion expenses,hospitalization expenses were compared.Results Hb level of the POTTS-E group was lower than that of the control group when out of surgery,postoperative 24 h,and end of hospitalization(P<0.05).Patients with complications in the POTTS-E group were less than that of the control group(20.69%vs.45.16%,P<0.05).The erythrocyte infusion rate and per capita infusion amount in the POTTS-E group were lower than those in the control group,but there was no statistically significant difference between the two groups(P>0.05).There were no deaths in either group.There was no statistical differences in first class nursing time,hospital stay,transfusion expenses and hospitalization expenses between the two groups(P>0.05).Conclusion POTTS-E guided individual blood transfusion strategy could be safely and effectively used in clinic which don`t increase the complication and mortality rate.