基于血液管理对25例先心术后出血病例的药学分析

Pharmaceutical analysis of 25 cases of bleeding after congenital heart surgery based on PBM

目的:基于心脏手术患者血液管理指南,分析术后出血的用药相关性,探索药学服务切入点。方法:回顾性筛选2021年11月1日至30日于阜外华中心血管病医院儿童心脏中心行先心手术、术后24 h内出血较多需要异体输血的病例。计算机检索中英文文献数据库及常用的指南收录数据库,筛选心脏手术患者血液管理相关指南,运用AGREEⅡ工具评价指南质量,查询药物使用指导意见,逐个分析筛选病例术后出血的可能原因。结果:筛选出先心术后出血病例25例。纳入5篇涉及心脏手术患者血液管理的指南,经AGREEⅡ工具评价,A级推荐指南1篇,B级推荐指南4篇。分析术后出血原因,发现9例术前贫血未得到纠正;22例术中未使用抗纤溶剂;23例术中使用肝素剂量>400 U·kg^(-1);22例术中鱼精蛋白与肝素的剂量比>1∶1。结论:外科医师和麻醉师对先心患儿围术期的血液管理策略与指南建议不太一致,药师应进一步提高医师对指南的依从性。

OBJECTIVE To analyze the medication correlation of postoperative hemorrhage and explore the entry point of pharmaceutical service based on the blood management guidelines for patients undergoing cardiac surgery.METHODS Children who underwent congenital heart surgery in the children’s heart center of Fuwai Huazhong cardiovascular hospital from November 1,2021 to November 30,2021,and who had more bleeding within 24 hours after surgery and required allogenetic blood transfusion were retrospectively selected.The Chinese and English literature databases and commonly-used guideline databases were searched,guidelines related to patient blood management(PBM)of cardiac surgery patients were screened.The AGREEⅡtool was used to evaluate the quality of the included guidelines and the guidance on medication were inquired.Possible causes of postoperative bleeding of screened cases were analyzed one by one based on guidelines searched.RESULTS 25 cases of bleeding after congenital heart surgery were screened.A total of 5 guidelines for blood management of cardiac surgery patients were included.There were 1 grade A and 4 grade B guidelines respectively after evaluation with AGREEⅡtool.The causes of postoperative bleeding of screened cases were analyzed,the results showed that 9 cases of preoperative anemia not corrected,antifibrotic drugs not used in 22 cases,the dosage of heparin used in 23 cases more than 400 U·kg^(-1),protamine:heparin>1∶1in 22 cases.CONCLUSION Surgeons and anesthesiologists’perioperative PBM strategies for children with congenital heart disease are not consistent with the recommendations of the guidelines.Pharmacists should further improve doctors’compliance with the guidelines.