我国紧急输血的可及性与便利性调查

A survey on the availability and convenience of emergency blood transfusion in China's Mainland

目的了解我国紧急输血的可及性与便利性现状,探讨改进策略。方法电子调查问卷由研究小组自制,经由中国医师协会急救复苏和灾难医学专业委员会等专业团体微信群向全国紧急用血和供血医师和技术人员推送,借助问卷星调查平台自动汇总数据,以SPSS21.0统计学软件分析数据。结果1)一般信息:共回收答卷3151份,有效问卷占85%(2678/3151),来自全国港澳台以外31个省、市、自治区1972家医疗机构。按地区分布,东、中、西部各占39%(1044/2678)、22%(577/2678)、39%(1057/2678),按等级医院分布,三级医院占78%(2099/2678)、二级及以下医院占22%(579/2678),按临床科室分布,急诊科60%(1607/2678)、重症科16%(425/2678)、其他科室24%(646/2678),按人员技术职称,高、中、初级人员各占34%(906/2678)、30%(798/2678)、36%(974/2678)。2)紧急输血的可及性:63%(1680/2678)有效答卷表示在过去3年(2017年~2020年)亲历无法及时获得足量急救用血情况(次数)≥1次,其中75%(1256/1680)发生在近1年内,近半年内西部地区51%(381/1057)或三级医院34%(713/2099)医务人员更多经历急救用血不足(P<0.05);易出现临床用血紧张的制剂依次是红细胞及全血43%(1151/2678)、血小板42%(1125/2678)、血浆其他成分血15%(402/2678);有48%(1274/2678)认为因不能及时获得足量的急救用血而"已对抢救质量造成明显不良影响"、40%(1081/2678)认为是"潜在医疗安全威胁"。3)紧急输血的便利性:患者紧急输血等候时间<0.5 h的占28%(741/2678)、<1 h占71%(1903/2678)、<2 h占90%(2547/2678),中部地区紧急输血等候时间0.5 h内占比50%(286/577),明显高于东部或西部地区(P<0.05);67%(889/2678)的有效答卷显示曾经历急救时血液库存耗竭,其中30%(792/2678)等待血库恢复供血时间≥8 h,西部地区80%(751/1057)有效答卷显示曾经历库存耗竭,明显高于东中部地区(P<0.05)。4)影响紧急输血的因素:献血不足56%(1485/2678)、医疗用血需求增长23%(619/2678)、储血保存期过期浪费7%(183/2678)、临床不合理用血6%(167/2678),西部地区60%(633/1057)的答卷认为献血不足,较东中部地区更多(P<0.05)。5)改进建议:加强无偿献血49%(1326/2678)、研发血液替代品24%(645/2678)、规范临床用血19%(499/2678)、改进血液存储技术以提高储存期8%(208/2678)等;西部地区53%(561/1057)的答卷建议加强无偿献血(P<0.05),东、中部或三级医院更多答卷建议"加强血液代用品研发"分别为26%(268/1044)、26%(152/577)、25%(553/2099)(P<0.05);高级技术职称答卷中56%(504/906)推荐加强无偿献血,而中初级技术职称答卷更多推荐血液代用品研发26%(453/1772)和改进血液存储技术0.9%(164/1772)(P<0.05)。结论现阶段我国血液储备尚不能完全满足临床紧急需求,在西部地区或三级医院更易受供血紧张困扰,需要采取加强无偿献血、研发血液替代品、规范临床用血、改进血液存储技术等措施进一步提升紧急输血的可及性和便利性。

Objective To investigate the availability and convenience of emergency blood transfusion in China's Mainland,and develop strategies for improvement.Methods The electronic questionnaire was self-made by the research team,and pushed to physicians and technicians related to emergency blood use and supply nationwide through the WeChat group of professional organizations such as the Chinese Medical Doctor Association′s Emergency Resuscitation and Disaster Medicine Professional Committee.The data was automatically aggregated by the internet survey platform named questionnaire star,and analyzed by statistics software SPSS 21.0.Results 1)General information:A total of 3151 questionnaires were collected,of which 85%(2678/3151),from 31 provinces,municipalities or autonomous regions in China's Mainland were valid,and 39%(1044/2678),22%(577/2678),39%(1057/2678)were from the east,middle and west region,respectively;78%(2099/2678)were from tertiary hospitals,and 22%(579/2678)secondary hospitals and below;60%(1607/2678),16%(425/2678),and 24%(646/2678)were from Emergency Department(EM),Intensive Care Department(ICU)and other departments respectively.The respondents with senior position titles took up 34%(906/2678)while those with intermediate and junior position titles took up 30%(798/2678)and 36%(974/2678)respectively.2)Availability:63%(1680/2678)of the respondents experienced untimely and insufficient blood supply at least once during June 2017 to May 2020,of which 75%(1256/1680)occurred in the past year.In the past half year,51%(381/1057)of respondents in the western region and 34%(713/2099)in tertiary hospitals experienced more emergency blood shortages(P<0.05).The most prone to clinical blood supply shortage were red blood cells and whole blood,platelets and other plasma components,accounting for 43%(1151/2678),42%(1125/2678)and 15%(402/2678),respectively.48%(1274/2678)respondents believed that the insufficient blood supply for emergency use"has caused a significant adverse effect on the quality of rescue",and 40%(1081/2678)believed that it was"a potential medical safety threat".3)Convenience:The waiting time for emergency blood transfusionwithin 0.5 h,1 h and 2 h accounted for 28%(741/2678),71%(1903/2678)and 90%(2547/2678),respectively.The waiting time of emergency blood transfusion within 0.5 h accounted for 50%(286/577)in central region,which was significantly higher than that in eastern or western region(P<0.05).67%(889/2678)of respondents experienced blood inventory depletion,of which 30%(792/2678)had to wait for more than 8 hours for resuming blood supply.80%(751/1057)of the respondents in the western region experienced inventory depletion,significantly higher than that in the central region(P<0.05).4)The influencing factors were mainly insufficient blood donation,growth of clinical demand in blood,blood waste due to expiration and clinical irrational use,accounted for 56%(1485/2678),23%(619/2678),7%(183/2678)and 6%(167/2678)respectively.60%(633/1057)of the respondents in the western region considered insufficient blood donation as the influencing factors,statistically higher than that in the eastern and central regions(P<0.05).5)Suggestions for improvement included more voluntary blood donation,development of blood substitutes,standardization of clinical blood use and extension of blood storage shelf life,accounted for 49%(1326/2678),24%(645/2678),19%(499/2678),and 8%(208/2678),respectively.53%(561/1057)of the respondents in the western region suggested strengthening voluntary blood donation(P<0.05),while 26%(268/1044),26%(152/577),25%(553/2099)of respondents in the eastern,central region and tertiary hospitals respectively suggested strengthening the research and development of blood substitutes(P<0.05).56%(504/906)of respondents with senior professional titles recommended strengthening voluntary blood donation,while 26%(453/1772)and 0.9%(164/1772)of those with intermediate and junior technical titles recommended research and development of blood substitutes and improvement of blood storage technology,respectively(P<0.05).Conclusion The whole blood reserve can not fully meet clinical emergency needs at present stage,especially in the western region and some tertiary hospitals,,showing the necessity to adopt comprehensive measures to further improve the availability and convenience of emergency blood transfusion,including strengthening voluntary blood donation,developing blood substitutes,prompting rational clinical blood use and improving blood storage technology.