缩短临床领取新鲜冰冻血浆等待时间在患者血液管理中的应用

Application of shorten waiting time for clinical receiving fresh frozen plasma in patient blood management

目的探讨缩短临床领取新鲜冰冻血浆(FFP)等待时间在患者血液管理(PBM)中的应用。方法选择2017年4月至11月,于重庆医科大学附属第一医院接受FFP输注治疗的4974例患者的临床病例资料为研究对象。根据缩短临床领取FFP等待时间整改措施的实施进程,将研究对象分为初步整改阶段组(n=2303,FFP领取时间为2017年6月至8月),持续整改阶段组(n=2048,FFP领取时间为2017年9月至11月),对照组(n=623,未实施相关整改措施,FFP领取时间为2017年4月至5月)。通过调查对照组和初步整改阶段组的临床病例资料,分析FFP领取环节中存在问题及其原因,制定缩短临床领取FFP等待时间的初步和持续整改措施。统计各组临床领取FFP的平均等待时间,以及初步整改阶段组和持续整改阶段组的预解冻FFP报废率和出库时间。3组临床领取FFP平均等待时间的总体比较,采用Kruskal-Wallis H检验,组间两两比较采用Mann-Whitney U检验,两两比较的检验水准校正采用Bonferroni校正法。初步整改阶段组与持续整改阶段组的预解冻FFP报废率比较,采用χ^2检验。结果①本研究中,持续整改阶段组、初步整改阶段组、对照组的全院临床领取FFP中位等待时间分别为8.0 min(5.0~14.8 min)、11.0 min(4.0~18.0 min)、19.0 min(16.0~23.0 min),3组总体比较,差异有统计学意义(χ^2=239.862,P<0.001);初步整改阶段组、持续整改阶段组与对照组分别比较,差异均有统计学意义(Z=-11.651,P<0.001;Z=-15.986,P<0.001)。3组的危重患者科室临床领取FFP中位等待时间分别为8.0 min(5.0~13.0 min)、11.5 min(4.0~17.0 min)、20.0 min(17.0~23.0 min),3组总体比较,差异有统计学意义(χ^2=150.978,P<0.001);初步整改阶段组、持续整改阶段组与对照组分别比较,差异均有统计学意义(Z=-9.225,P<0.001;Z=-12.602,P<0.001);初步整改阶段组与持续整改阶段组比较,差异亦有统计学意义(Z=-2.176,P=0.030)。②初步整改阶段组预解冻FFP共6581袋,其中7袋报废,报废率为0.11%(7/6581);持续整改阶段组预解冻FFP共5853袋,其中2袋报废,报废率为0.03%(2/5853);2组预解冻FFP的报废率比较,差异无统计学意义(χ^2=2.232,P=0.135)。③初步整改阶段组和持续整改阶段组中,未报废的预解冻FFP为12425袋,其中10729袋(86.35%)的出库时间<12 h;1696袋(13.65%)出库时间为13~20 h。结论本研究采取的缩短临床领取FFP等待时间措施,可有效缩短领取FFP等待时间,合理控制报废率,提高PBM效率。但是,本研究结果仅限于单中心的回顾性研究,缩短临床领取FFP时间在PBM中的应用价值,尚需多中心、前瞻性研究进一步证实。

Objective To explore the applications of shorten waiting time for clinical receiving fresh frozen plasma(FFP)in patient blood management(PBM).Methods From April to November 2017,a total of 4974 copies of clinical data from patients who receiving FFP infusion treatment in the First Affiliated Hospital of Chongqing Medical Universityin were selected as research subjects.According to the implementation of rectification measures for shorten waiting time for clinical receiving FFP,the research subjects were divided into preliminary rectification stage group(n=2303,FFP receiving date was from June to August 2017),continuous rectification stage group(n=2048,FFP receiving date was from September to November 2017),and control group(n=623,not implemented any rectification measures,FFP receiving data was from April to May 2017).By investigating the clinical data of the control group and preliminary rectification stage group,analyzed the problems and their causes existing in clinical receiving FFP,and formulated preliminary and continuous rectification measures to shorten waiting time for clinical receiving FFP.Calculate the average waiting time for clinical receiving FFP in each group,as well as the scrap rate and outbound time of pre-thawed FFP in preliminary rectification stage group and continuous rectification stage group.The overall comparison of the average waiting time for clinical receiving FFP among the three groups,was performed using the Kruskal-Wallis H test.The pairwise comparison between groups was performed using the Mann-Whitney U test,and the test level correction of the pairwise comparison was performed using the Bonferroni correction method.The comparison of scrap rate of pre-thawed FFP between preliminary rectification stage group and continuous rectification stage group was performed using Chi-square test.Results①In this study,the median waiting time for clinical receiving FFP of whole hospital in the continuous rectification stage group,preliminary rectification stage group,and control group were 8.0 min(5.0-14.8 min),11.0 min(4.0-18.0 min)and 19.0 min(16.0-23.0 min),respectively.And the difference of median waiting time for clinical receiving FFP in whole hospital among three groups was statistically significant(χ^2=239.862,P<0.001),the differences of that compared the continuous rectification stage group and preliminary rectification stage group with control group were statistically significant(Z=-11.651,P<0.001;Z=-15.986,P<0.001).The median waiting time for clinical receiving FFP in department of critical patients were 8.0 min(5.0-13.0 min),11.5 min(4.0-17.0 min),and 20.0 min(17.0-23.0 min),respectively.And the difference of median waiting time for clinical receiving FFP in department of critical patients among three groups was statistically significant(χ^2=150.978,P<0.001),the differences of that compared the continuous rectification stage group and preliminary rectification stage group with control group were statistically significant(Z=-9.225,P<0.001;Z=-12.602,P<0.001),and the difference of that compared the preliminary rectification stage group with continuous rectification stage group was statistically significant(Z=-2.176,P=0.030).②In the preliminary rectification stage group,a total of 6581 bags of FFP were pre-thawed,of which 7 bags were scrapped,and the scrap rate was 0.11%(7/6581).In the continuous rectification stage group,a total of 5853 bags of FFP were pre-thawed,of which 2 bags were scrapped,and the scrap rate was 0.03%(2/5853).And there was no significant difference in the scrap rates between two groups(χ^2=2.232,P=0.135).③In the preliminary and continuous rectification stage groups,the un-scrap pre-thawed FFP was 12425 bags,of which 10729 bags(86.35%)had a outbound time<12 h,and 1696 bags(13.65%)had a outbound time with 13-20 h.Conclusions The measures to shorten the waiting time for clinical receiving FFP adopted in this study is worth promoting,which could effectively shorten the waiting time for clinical receiving FFP,reasonably control the scrap rate,and improve the efficiency of PBM.However,the results of this study are limited to a single-center retrospective study.The actual value of shorten the waiting time for clinical receiving FFP in PBM still needs to be further confirmed by a multi-center prospective studies.