急诊输血指征评分指导急诊患者输血的安全性与可行性研究

Safety and feasibility of emergency transfusion score in guiding blood transfusion of emergency patients

目的探讨使用急诊输血指征评分(ETS)是否能有效安全地应用于急诊患者。方法选取遵义医科大学附属医院2014—2016年3年收治的17 235例急诊患者为研究对象。将2014年1月至2015年6月未使用ETS评分的急诊患者8 155例设为N-ETS组,2015年7月至2016年12月使用ETS评分的急诊患者9 080例设定为ETS组。查阅ETS评分实施前后麦迪斯顿手术麻醉系统的麻醉记录,比较两组急诊输血患者的一般情况、输血情况、转归情况、急诊患者输血科室以及用血情况。结果 N-ETS组与ETS组急诊患者的输血率(18.52%vs 14.30%)、异体红细胞输注率(16.91%vs 12.15%)、人均红细胞输注[4 (2,5) U vs 2 (2,4) U]、自体血回收量[600 (300,1 000) mL vs800 (500,1 200) mL]比较差异均有统计学意义(P<0.05);N-ETS组与ETS组患者的自体血使用率(2.06%vs 2.11%)、死亡率(2.78%vs 2.62%)、患者术后进入ICU率(7.02%vs 7.32%)比较差异均无统计学意义(P>0.05);ETS组急诊输血患者输血前四位科室依次是妇产科、神经外科、烧伤整形科、普外科,所占比例为28.7%、15.9%、10.6%和8.9%,N-ETS组急诊输血患者输血前四位科室依次是妇产科、普外科、神经外科、烧伤整形外科,所占比例为30.1%、15.0%、12.3%和9.1%。结论使用ETS评分能有效降低急诊患者的血液不合理输注,增加自体血使用率,提高输血效能。

Objective To investigate whether the emergency transfusion score(ETS)can be effectively and safely applied to emergency patients.Methods A total of 17235 emergency patients admitted to the Affiliated Hospital of Zunyi Medical University from 2014 to 2016 were selected as the research objects.The 8155 emergency patients who did not use the ETS score from January 2014 to June 2015 were set as the N-ETS group,and the 9080 emergency patients who used the ETS score from July 2015 to December 2016 were set as the ETS group.The anesthesia records of the Mediston surgical anesthesia system before and after the implementation of the ETS score were consulted,and the general condition,blood transfusion,outcome,blood transfusion department,and blood use were compared between the two groups.Results There were statistically significant differences(P<0.05)between the N-ETS group and the ETS group in blood transfusion rate(18.52%vs 14.30%),allogeneic red blood cell transfusion rate(16.91%vs 12.15%),per capita red blood cell transfusion with 4(2,5)U vs 2(2,4)U,and the amount of autologous blood recovered with 600(300,1000)mL vs 800(500,1200)mL.There was no statistically significant differences(P>0.05)between the two groups in the use of autologous blood(2.06%vs 2.11%),the mortality rate(2.78%vs 2.62%),and the rate of patients entering ICU after surgery(7.02%vs 7.32%).The top four departments for blood transfusion were Department of Obstetrics and Gynecology,Department of Neurosurgery,Department of Burn and Plastic Surgery,and Department of General Surgery in the ETS group(accounting for 28.7%,15.9%,10.6%,and 8.9%),and the top four departments in the N-ETS group were Department of Obstetrics and Gynecology,Department of General Surgery,Department of Neurosurgery,and Department of Burn and Plastic Surgery,accounting for 30.1%,15.0%,12.3%,and 9.1%.Conclusion The use of ETS score can effectively reduce the irrational blood transfusion of emergency patients,increase the use rate of autologous blood,and improve the efficiency of blood transfusion.