四川某三甲医院2017-2018年各年龄段患者临床用血的分析

Clinical Blood Utilization of Patients at Different Ages for a Hospital in Sichuan from 2017 to 2018

目的:分析不同年龄组患者血液制剂的使用情况。方法:回顾性分析四川省人民医院2017-2018年10784例输血患者的临床资料,对患者临床用血的基本情况进行统计描述;根据年龄和疾病进行分组,分析不同疾病不同年龄组各种血液制剂的使用情况。结果:10784例输血患者的年龄主要集中在40-80岁,最常见的疾病为肿瘤(约占28%)。本院平均每年输注红细胞24936.5 U,血小板3795治疗量,血浆2455500 ml,冷沉淀3461.5 U。多数血液系统恶性肿瘤和肝硬化患者输注了两种或两种以上血液制剂,其中血液系统恶性肿瘤患者使用较多的是辐照红细胞悬液(76.4%)、血小板(67.8%)和悬浮红细胞(59.9%),肝硬化患者使用最多的是悬浮红细胞(64.2%)和新鲜冰冻血浆(59.4%)。创伤和慢性肾脏病患者最常使用的血液制剂为悬浮红细胞(分别为95.7%和91.5%)。在血液系统恶性肿瘤患者中,年龄≥60岁患者辐照红细胞悬液、血小板和新鲜冰冻血浆的输注量均低于<60岁的患者(P<0.05);在创伤患者中,年龄≥60岁患者悬浮红细胞的输注量低于<60岁的患者(P<0.05)。在血液系统恶性肿瘤、创伤和肝硬化患者中,年龄≥60岁患者输注血小板和(或)血浆的比例均低于<60岁的患者(P<0.05),且均更倾向于只输注红细胞。结论:同一种疾病中,年龄<60岁和≥60岁患者输注血液制剂的情况存在差异,60岁以上老年患者只输注红细胞的可能性更大,纠正缺氧是临床的主要考量,应根据患者人群制定用血计划,并根据不同人群制定不同的输血策略,最大程度提高血液的使用效率。

Objective:To analyze the use of blood products in patients at different ages.Methods:The clinical datas of the 10784 patients transfused in Sichuan provincial people’s hospital at 2017-2018 were retrospectively analyzed,and the basic condition of clinical blood using was statistically described.The patients were divided into the groups according to age and disease,then the use of various blood products in the patients with different diseases in different age groups was analyzed.Results:The age of blood transfusion patients was mainly 40-80 years old,and the most common disease was tumor(about 28%).The average annual transfusion volumes of red blood cells(RBC)were24936.5 U,of platelets(PLT)were 3795 therapeutic doses of plasma were 2455500 ml,of cryoprecipitate were3461.5 U in our hospital.Most patients with hematologic malignancies and liver cirrhosis were transfused with two or more blood productions.For the patients with hematologic malignancies,the irradiated RBC(76.4%),PLT(67.8%),and suspended RBC(59.9%)were commonly used.And for liver cirrhosis patients,the suspended RBC(64.2%)and fresh frozen plasma(FFP)(59.4%)were commonly used.For the patients with trauma and chronic kidney disease(CKD),the suspended RBC(95.7%and 91.5%,respectively)was commonly used.In hematologic malignancies patients,the transfusion volume of irradiated RBC,PLT and FFP in the patients aged≥60 years old was lower than that in patients aged<60 years old(P<0.05);in trauma patients,the transfusion volume of suspended RBC in the patients aged≥60 years old was lower than that in patients aged<60 years old(P<0.05).In hematologic malignancies,trauma and liver cirrhosis patients,the proportion of PLT and/or plasma transfusion in the patients aged≥60 years old was lower than that in patients aged<60 years old(P<0.05),and the elderly patients were more likely to receive RBC transfusion only.Conclusion:There is a difference in the distribution of blood product between the patients aged<60 years old and≥60 years old in the same disease,and it is more likely that the elderly patients(aged≥60 years old)receive RBC transfusion only,and correction of hypoxia is a major clinical consideration,so blood using plans should be made according to the patient population,moreover,the different transfusion strategies should be developed for different population to maximize the efficiency of blood using.