Clinical nursing value of predictive nursing in reducing complications of pregnant women undergoing short-term massive blood transfusion during cesarean section

BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.

Survey on Blood Transfusion Practices among Medical and Paramedical Staff in the Pediatric Unit of the Mohammed VI University Hospital in Marrakesh, Morocco

Blood transfusion is a complex activity, involving many actors. As a high-risk activity, it necessitates the implementation of specific methods for effective control. The safety of blood transfusion is significantly influenced by the beliefs of healthcare workers and organizational factors, constituting two major considerations. We conducted a cross-sectional, descriptive, and analytical survey to examine the knowledge and practices related to transfusion among the medical and paramedical staff at the Pediatric Department (Mother-Child) of CHU Mohammed VI from September 1, 2022, to December 31, 2022. Among the 135 staff members interviewed, only 41% had received training in blood transfusion. A majority (65.2%) of the staff noted that a mismatch in cross-matching led to transfusion complications. Two-thirds (66.7%) identified chills as the primary clinical sign of potential accidents. Regarding elements to monitor during a reaction, hemolysis (78.5%) and temperature (76.3%) were most commonly mentioned. Surprisingly, more than half (53.3%) of the personnel interviewed did not conduct post-transfusion monitoring. This survey highlighted significant deficiencies in knowledge and practices related to transfusion. To address these issues, we recommend implementing guidelines and providing tailored training for the staff, aiming to rectify these deficiencies and enhance overall practices.

The Impact of Blood Transfusion on the Efficiency of Stem Cell Transplants

Background: While blood product transfusion is essential for managing hematologic deficits in Allogenic Hematopoietic stem cell transplant (AHSCT) recipients, it has risks including infectious disease transmission, alloimmunization, and transfusion reactions. These risks have sparked an ongoing debate regarding the overall impact of transfusions on patient outcomes. Thus, this study aimed to evaluate the impact of Red Blood Cells (RBCs) and/or platelet transfusion on the infection incidence and overall survival in AHSCT patients. Methods: We performed a retrospective analysis of clinical and laboratory data of sixty adult patients with primary malignant hematological disorder who had undergone AHSCT. Participants’ data were categorized into two groups;Group 1 (low transfusion group) consisted of patients receiving 10 units. Quantitative data were expressed as mean ± SD. The t-test of significance and Chi-square (χ2) test were used, with p ≤ 0.05 considered significant. Result: A total of 60 patients’ data was included. In Group 1, out of 30 patients, 13 (43.33%) developed infections. In contrast, Group 2 had 21 (70%) out of 30 patients develop infections. Group 1 had a higher survival rate (57.8%) than Group 2 (transfusion > 10 units) (46.2%) with a chi-square value = 23.56, and p-value Conclusion: The volume of blood product transfusions has a considerable impact on patient outcomes, particularly infection and survival rates. Additional long-term prospective studies and larger randomized controlled trials are needed to strengthen the evidence for determining transfusion protocols for these patients.

The Effect of the Direct Anti-Human Globulin Test on the Clinical Outcome of Patients Receiving Blood Transfusion

Objective:To study the effect of the direct anti-human globulin test on the clinical efficacy of blood transfusion patients.Methods:52 transfused patients were selected for this study,of which 26 cases with positive direct anti-human globulin tests were included in the positive group,and another 26 cases with negative direct anti-human globulin tests were included in the negative group.The apparent efficacy of the patients in the two groups after blood transfusion was compared.Results:After blood transfusion,the apparent efficacy of the negative group was significantly higher,P<0.05;in the positive group,the proportion of the predominantly multi-antibody group was the highest;after blood transfusion,the post-transfusion apparent efficacy of the simple IgG group was higher than that of the multi-antibody group,P<0.05;comparing the intensity of the different antibodies resulted in the 1+group,and the 3+to 4+groups were significantly lower after blood transfusion,P<0.05.Conclusion:The use of the direct antiglobulin test in transfused patients showed that patients with positive results would have better clinical efficacy.Direct anti-human globulin tests will have an impact on the clinical efficacy of blood transfusion in patients with positive results,so it is very important to carry out a direct anti-human globulin test on blood transfusion patients.

Blood typing and transfusion therapy in a patient with A2 subtype acute myeloid leukemia M2:A case report

BACKGROUND Acute myeloid leukemia(AML)is one of the most common types of leukemia in adults.However,AML is relatively rare in the population overall,accounting for only about 1 percent of all cancers.Treatment for AML can be very effective for some patients,yet it leaves others with serious and even life-threatening side effects.Chemotherapy is still the primary treatment for most AML,but over time,leukemia cells become resistant to chemotherapy drugs.In addition,stem cell transplantation,targeted therapy,and immunotherapy are currently available.At the same time,with the progression of the disease,the patient may have corresponding complications,such as coagulation dysfunction,anemia,granulocytopenia,and repeated infection,so transfusion supportive therapy will be involved in the overall treatment regime.To date,few articles have reported on blood transfusion treatment options for patients with ABO subtypes AML-M2.Blood transfusion therapy is an important supportive treatment for AML-M2,and accurate determination of patients'blood type is one of the most important steps in the treatment process.In this study,we explored blood typing and supportive treatment strategies for a patient with A2 subtype AML-M2 to provide the basis for treatment for all patients.CASE SUMMARY In order to determine the blood type of the patient,serological and molecular biological methods were used for reference tests,and the genetic background was studied to determine the patient's final blood type and select the appropriate blood products for infusion treatment.According to the results obtained by serological and molecular biological methods,the blood type of the patient was A2 subtype;the genotype was A02/001;the irregular antibody screening was negative,and anti-A1 was found in the plasma.According to the overall treatment plan,active anti-infection,elevated cells,component blood transfusion support,and other rescue and supportive treatments were given,and the patient successfully passed the stage of myelosuppression after chemotherapy.Re-examination of bone marrow smears showed that AL was in complete remission of bone marrow signs,and minimal residual leukemia lesions suggested no cells with obvious abnormal immunophenotype(residual leukemia cells<10-4).CONCLUSION The infusion of patients with A2 subtype AML-M2 with A irradiated platelets and O washing red blood cells can meet the needs of clinical treatment.

TSR:A User-friendly R Shiny Application for Assessment of Optimal Blood Product Selection in ABO-incompatible Hematopoietic Stem Cell Transplantation

Objective:Patients undergoing hematopoietic stem cell transplant(HSCT)need frequent transfusions,until their red blood cells(RBCs)and platelets start to recover.The safe transfusion for patients who receive ABO-incompatible HSCT is essential to the transplant process.To date,there is no user-friendly tool to choose the right blood product for transfusion treatment,despite the number of guidelines and expert advice on the subject.Methods:R/shiny is a powerful programming language for clinical data analysis and visualization.It can create interactive web applications that work in real-time.The web application named TSR was built using R programming,simplifying blood transfusion practice for ABO-incompatible HSCT witha one-click solution.Results:The TSR is divided into four main tabs.The home tab provides an overview of the application,while RBC,plasma and platelet transfusion tabs offer tailored suggestions for blood product selection in each category.Unlike traditional methods that rely on treatment guidelines and specialist consensus,TSR leverages the power of the R/Shiny interface to extract critical content based on user-specified parameters,providing an innovative approach to improve transfusion support.Conclusion:The present study highlights that the TSR enables real-time analysis,and promotes transfusion practice byoffering a unique and efficient one-key output for blood product selection to ABO-incompatible HSCT.TSR has the potential to become a widely-utilized tool for transfusion services,providing a reliable and user-friendly solution that enhances transfusion safety in clinical practice.

Machine Learning for Detecting Blood Transfusion Needs Using Biosignals

Adequate oxygen in red blood cells carrying through the body to the heart and brain is important to maintain life.For those patients requiring blood,blood transfusion is a common procedure in which donated blood or blood components are given through an intravenous line.However,detecting the need for blood transfusion is time-consuming and sometimes not easily diagnosed,such as internal bleeding.This study considered physiological signals such as electrocardiogram(ECG),photoplethysmogram(PPG),blood pressure,oxygen saturation(SpO2),and respiration,and proposed the machine learning model to detect the need for blood transfusion accurately.For the model,this study extracted 14 features from the physiological signals and used an ensemble approach combining extreme gradient boosting and random forest.The model was evaluated by a stratified five-fold crossvalidation:the detection accuracy and area under the receiver operating characteristics were 92.7%and 0.977,respectively.

Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

BACKGROUND Gastric cancer(GC)is still a prevalent neoplasm around the world and its main treatment modality is surgical resection.The need for perioperative blood transfusions is frequent,and there is a long-lasting debate regarding its impact on survival.AIM To evaluate the factors related to the risk of receiving red blood cell(RBC)transfusion and its influence on surgical and survival outcomes of patients with GC.METHODS Patients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated.Clinicopathological and surgical characteristics data were collected.The patients were divided into transfusion and non-transfusion groups for analysis.RESULTS A total of 718 patients were included,and 189(26.3%)patients received perioperative RBC transfusion(23 intraoperatively,133 postoperatively,and 33 in both periods).Patients in the RBC transfusions group were older(P<0.001),and had morecomorbidities(P=0.014),American Society of Anesthesiologists classification III/IV(P<0.001),and lower preoperative hemoglobin(P<0.001)and albumin levels(P<0.001).Larger tumors(P<0.001)and advanced tumor node metastasis stage(P<0.001)were also associated with the RBCtransfusion group.The rates of postoperative complications(POC)and 30-d and 90-d mortalitywere significantly higher in the RBC transfusion group than in the non-transfusion group.Lowerhemoglobin and albumin levels,total gastrectomy,open surgery,and the occurrence of POC werefactors associated with the RBC transfusion.Survival analysis demonstrated that the RBCtransfusions group had worse disease-free survival(DFS)and overall survival(OS)compared withpatients who did not receive transfusion(P<0.001 for both).In multivariate analysis,RBCtransfusion,major POC,pT3/T4 category,pN+,D1 lymphadenectomy,and total gastrectomywere independent risk factors related to worse DFS and OS.CONCLUSIONPerioperative RBC transfusion is associated with worse clinical conditions and more advancedtumors.Further,it is an independent factor related to worse survival in the curative intentgastrectomy setting.

The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

Impact of perioperative blood transfusion on oncological outcomes in ampullary carcinoma patients underwent pancreaticoduodenectomy

BACKGROUND The effect of perioperative blood transfusion(PBT)on the prognosis of ampullary carcinoma(AC)is still debated.AIM To explore the impact of PBT on short-term safety and long-term survival in AC patients who underwent pancreaticoduodenectomy.METHODS A total of 257 patients with AC who underwent pancreaticoduodenectomy between 1998 and 2020 in the Cancer Hospital,Chinese Academy of Medical Sciences,were retrospectively analyzed.We used Cox proportional hazard regression to identify prognostic factors of overall survival(OS)and recurrencefree survival(RFS)and the Kaplan-Meier method to analyze survival information.RESULTS A total of 144(56%)of 257 patients received PBT.The PBT group and nonperioperative blood transfusion group showed no significant differences in demographics.Patients who received transfusion had a comparable incidence of postoperative complications with patients who did not.Univariable and multivariable Cox proportional hazard regression analyses indicated that transfusion was not an independent predictor of OS or RFS.We performed Kaplan-Meier analysis according to subgroups of T stage,and subgroup analysis indicated that PBT might be associated with worse OS(P<0.05)but not RFS in AC of stage T1.CONCLUSION We found that PBT might be associated with decreased OS in early AC,but more validation is needed.The reasonable use of transfusion might be helpful to improve OS.

Comparison of the conventional tube and erythrocyte-magnetized technology in titration of red blood cell alloantibodies

BACKGROUND Erythrocyte alloantibodies are mainly produced after immune stimulation,such as blood transfusion,pregnancy,and transplantation,and are the leading causes of severe hemolytic transfusion reactions and difficulty in blood grouping and matching.Therefore,antibody screening is critical to prevent and improve red cell alloantibodies.Routine tube assay is the primary detection method of antibody screening.Recently,erythrocyte-magnetized technology(EMT)has been increasingly used in clinical practice.This study intends to probe the application and efficacy of the conventional tube and EMT in red blood cell alloantibody titration to provide a reference for clinical blood transfusion.AIM To investigate the application value of conventional tube and EMT in red blood cell alloantibody titration and enhance the safety of blood transfusion practice.METHODS A total of 1298 blood samples were harvested from blood donors at the Department of Blood Transfusion of our hospital from March 2021 to December 2022.A 5 mL blood sample was collected in tubing,which was then cut,and the whole blood was put into a test tube for centrifugation to separate the serum.Different red blood cell blood group antibody titers were simultaneously detected using the tube polybrene test,tube antiglobulin test(AGT),and EMT screening irregular antibody methods to determine the best test method.RESULTS Simultaneous detection was performed through the tube polybrene test,tube AGT and EMT screening irregular antibodies.It was discovered that the EMT screening irregular antibody method could detect all immunoglobulin G(IgG)and immunoglobulin M(IgM)irregular antibodies,and the results of manual tube AGT were satisfactory,but the operation time was lengthy,and the equipment had a large footprint.The EMT screening irregular antibody assay was also conducted to determine its activity against type O Rh(D)red blood cells,and the outcomes were satisfactory.Furthermore,compared to the conventional tube method,the EMT screening irregular antibody method was more cost-effective and had significantly higher detection efficiency.CONCLUSION With a higher detection rate,the EMT screening irregular antibody method can detect both IgG and IgM irregular antibodies faster and more effectively than the conventional tube method.

中国对“一带一路”沿线直接投资的减贫效应研究

近年来,中国对“一带一路”沿线国家直接投资持续增加,合作领域不断拓展,合作程度不断深入,在此背景下探讨中国对外直接投资对沿线国家是否具有优良的减贫效应,减贫效应是否会因国家属性不同而产生异质性的影响,这种减贫效应又是通过何种渠道、何种机制来传导的,这一系列问题的解答对理论与实践都具有重大意义。文章基于2009—2019年“一带一路”沿线63国的面板数据,依照所属区域大致将沿线63个国家划分为六大板块,构建与对外直接投资的减贫效应相关的计量模型,实证分析中国对东道国直接投资的减贫效应,并采取中介效应检验的方法探索直接投资的减贫效应传导机制。研究表明:中国对外直接投资对降低东道国贫困率的成效显著,为当地经济发展带来强劲的“拉力”,显著地促进了“一带一路”沿线国家的贫困人口的减少。异质性分析表明:这种减贫效应不存在明显的地理区域偏向性,也不以国家经济发展水平为绝对界限;以“是否布局有孔子学院”作为代理变量来衡量文化距离的远近,在“文化距离近”的国家效果更为优良,而对于“文化距离远”的国家影响并不显著。中介效应分析表明:在中国对外直接投资发挥减贫作用的过程中,就业创造与基础设施建设承担了部分中介效应的功能,通过这两种机制,东道国经济的自生能力得到有效提升,授人以鱼不如授人以渔,中国通过创造就业岗位与完善基础建设“双渠道”,提升东道国的自生能力,为当地经济可持续发展带来了源源不断的动力,发展步入良性循环。通过关注贫困群体的能力建设,因地制宜地挖掘贫困地区潜在市场的比较优势,来实现自主减贫。与“输血式”减贫相比,这种“造血式”的减贫方式以提升自生能力为导向,更为有效而持续。为避免模型中内生性问题对研究结论的影响,以中国对外直接投资的一阶滞后项作为工具变量重新进行回归,原结论仍然成立;为保证文章实证分析结论的可靠性,采取分别替换核心解释变量与被解释变量的方法进行稳健性检验,最终的研究结论具有稳健性。基于上述分析,文章提出以就业岗位创造为本、以人才培训为源、以基础设施建设为先,进一步优化中国对外直接投资流向,促进减贫合作。

外科手术患者术后切口感染的危险因素分析

目的分析外科手术患者术后切口感染的危险因素。方法回顾性分析2022年1月至2022年12月于九江市第一人民医院进行外科手术治疗的256例患者的临床资料,所有入选者均进行相应的手术治疗,根据术后切口感染发生情况分组,比较两组相关资料,分析外科发生切口感染的相关因素。结果256例患者中,有20例发生切口感染,术后切口感染发生率为7.81%(20/256)。单因素分析结果显示,感染组年龄>60岁、合并糖尿病、术前贫血、手术时间≥3 h、急诊手术、围手术期输血占比均高于未感染组,差异有统计学意义(P<0.05)。logistic回归分析结果显示,年龄>60岁(OR=6.316,95%CI=2.214~18.018,P=0.001)、合并糖尿病(OR=4.787,95%CI=1.877~12.209,P=0.001)、术前贫血(OR=4.756,95%CI=1.860~12.163,P=0.001)、手术时间≥3 h(OR=6.367,95%CI=2.458~16.491,P<0.001)、急诊手术(OR=6.574,95%CI=2.547~16.968,P<0.001)、围手术期输血(OR=5.441,95%CI=2.111~14.024,P<0.001)是外科手术患者术后切口感染的独立危险因素(P<0.05,OR>1)。结论手术为重要的治疗方法,但因本身具有创伤性,术后切口感染发生率较高,对于年龄>60岁、合并糖尿病、术前贫血、手术时间≥3 h、急诊手术、围手术期输血的患者,需重点管理,尽可能降低切口感染发生率。

基于电子病历六级评审和等级医院评审的智能化输血系统的设计与应用

目的构建智能化的闭环输血系统,满足国家电子病历六级和等级医院评审细则要求,提升用血的安全性和合理性。方法分析现有系统的缺陷,以输血知识库、临床决策支持系统等工具为媒介对现有系统进行改造和升级,利用集成平台与医院信息系统、电子病历、手麻系统及输血系统的信息交互,实现临床用血质量控制指标的一键上报功能,实现输血管理从申请、配血、用血及用血后效果评价的全流程管理。比较系统上线前后的输血质量及终末病历检查结果进行系统成效评价。结果系统上线后,输血申请合理率、标本正确率、未超时输注率和输血不良反馈率较上线前显著提高(P<0.01),输血终末病历较上线前更加规范化、标准化(P<0.01)。结论智能化的闭环输血管理系统在临床用血的关键环节设置质控提醒,建立安全、合理、规范的用血模式,有效降低了输血风险,提高了医院用血的管理水平。

基于持续改进理念促进二级医疗机构输血科(血库)建设:以河北省为例

目的调查河北省二级医疗机构输血科(血库)建设持续改进效果。方法选取全省35家二级医疗机构输血科(血库)作为调查对象,依据《河北省二级医疗机构输血科建设和管理评价标准》,于2021年7月、2022年8月分别进行调研,比较督导效果。结果经过督导,河北省二级医疗机构输血科(血库)设置、房屋设施、人力资源管理、仪器设备、质量管理体系、血液库存管理、输血相容性检测2022年显著优于2021年,两者比较差异有统计学意义(P<0.05);而清洁消毒、血液发放管理、信息管理系统、室内质控和室间质评2022年与2021年比较差异无统计学意义(P>0.05)。结论河北省二级医疗机构输血科(血库)建设持续改进取得了明显成效,但在清洁消毒、信息管理系统、室内质控和室间质评等方面仍需进一步改进。

中华跌打丸活血化瘀作用的实验研究

目的:观察中华跌打丸对大鼠急性血瘀模型的体外血栓形成、血液黏度、血小板聚集率和对小鼠微循环障碍模型耳郭微循环的影响,评价中华跌打丸活血化瘀的作用。方法:通过注射肾上腺素加冰水刺激的方法建立大鼠急性血瘀模型,测定体外血栓形成和血液黏度;按照Born氏比浊法加入诱导剂诱导聚集测定大鼠血小板聚集率;尾静脉注射15%高分子右旋糖酐造成微循环障碍,观察小鼠耳郭各时段微动脉和微静脉管血液流速和血管管径的变化。结果:中华跌打丸可降低血瘀模型大鼠的血液黏度,在切变率150 S^(-1)、60 S^(-1)及5 S^(-1)下的全血黏度均显著降低(P<0.05),明显缩短血瘀模型大鼠血栓长度,减轻血栓湿重和干重(P<0.05,P<0.01);中华跌打丸具有抑制血小板聚集的作用,各剂量均能明显降低ADP诱导的大鼠血小板聚集率(P<0.05,P<0.01);中华跌打丸对高分子右旋糖酐所致小鼠耳郭微循环障碍有明显改善作用,于造模10 min、20 min、30 min时增加血液流速(P<0.05,P<0.01),扩大微动脉、微静脉管径(P<0.05,P<0.01),减轻红细胞聚集(P<0.05,P<0.01)。结论:中华跌打丸可明显改善血液黏度,抑制血小板聚集,改善微循环障碍,有较好的活血化瘀作用。

Ax22亚型导致家族性血型鉴定错误的研究

目的通过对ABO血型为Ax22/B型的患者及其家属因A亚型造成血清学血型鉴定错误的案例进行分析,总结ABO血型鉴定过程中的注意事项及A亚型的输血策略。方法分别选取A、B两种不同厂家的微柱凝胶血型鉴定卡及试管法在常温和4℃孵育10 min两种条件下对患者及其子女进行血清学血型鉴定;对所有标本进行吸收放散试验及血型基因鉴定;分别用微柱凝胶法和聚凝胺法对同一组标本进行交叉配血。结果B试剂卡凝集强度明显高于A试剂卡,且正定型B试剂卡可以在常温下检测到A抗原,A试剂卡仅在4℃孵育10 min后才可检测到A抗原。试管法血型可明确显示A亚型的反应格局。吸收放散试验显示所有标本红细胞表面均存在A抗原,经基因测序患者为Ax22/B.01,其子女基因型为Ax22/O.01.01。微柱凝胶法交叉配血相合,聚凝胺法镜下可见细胞凝集,交叉配血不合。结论Ax22会造成检测结果假阴性,如正反定型不一致或者对检测结果有任何疑问,应选用试管法或其他检测系统进行复核,必要时进行基因检测;Ax22亚型在配血时有假阴性的可能,有较高的输血风险。

《血液储存标准》修订的思考与启示

国家卫生健康委员会新近正式批准发布的卫生行业标准WS 399-2023《血液储存标准》是WS 399-2012《血液储存要求》的最新修订版本,主要规定了全血、红细胞、血小板、粒细胞、血浆、辐照血等的储存要求,适用于采供血机构和医疗机构,是安全用血的基础和保障。

患者临床输血情况调查与分析

目的:通过对多所医院患者输血情况的调查和分析,为不同病种患者的输血评估提供循证医学依据,实现精准输血。方法:调研分析2021年7月—12月上海用血量最多的2所综合性三级医院和3所综合性二级医院共16254例输血患者的病例资料,调查分析患者血型、科室、病种、输血量、输血成分等。结果:悬浮红细胞输注量在三级医院总量为37813 U,人均输注量为2(2,4)U,二级医院总量为45577 U,人均输注量为4(2,8)U,两者差异具有统计学意义(P<0.05);冰冻血浆输注量在三级医院总量为33689 U,人均输注量为2(0,4)U,二级医院总量为26822 U,人均输注量为0(0,4)U,两者差异具有统计学意义(P<0.05);单采血小板输注量在三级医院总量为3586 U,人均输注量为0(0,0)U,二级医院总量为23414 U,人均输注量为0(0,5)U,两者差异具有统计学意义(P<0.05)。血液科患者的悬浮红细胞和单采血小板输注量最高,分别为6(2,11)U和5(1,9)U,冰冻血浆输注量以神经内科患者[4(0,32)U]最高。结论:不同规模医院不同种类的血液制品在不同科室的输注量存在较大差异。各医院应根据自身医院和不同科室疾病患者的情况,以循证医学为依据,制定不同患者的输血评估方案,做到精准输血,保证临床科学合理用血。

急性Stanford A型主动脉夹层患者围术期用血情况分析

目的回顾性分析本院322例Stanford A型主动脉夹层患者的输血情况,探讨患者围术期血液输注的影响因素及效果评价。方法选择2020年10月-2023年10月本院行手术治疗的Stanford A型主动脉夹层患者,分析不同手术方式间血液输注的差异、血常规及凝血功能指标监测,对大量血液输注的影响因素进行评价。结果Stanford A型主动脉夹层患者中术中异体红细胞输注率63.98%,围术期异体红细胞输注率85.71%。行Bentall手术术中红细胞、血浆、冷沉淀、血小板输注量分别为(3.75±3.81)U、(608.13±314.77)mL、(15.25±8.39)U、(1.53±0.78)治疗量,与行Sun′s手术的输注量(3.13±4.04)U、(707.61±461.21)mL、(15.79±6.59)U、(1.54±0.64)治疗量及行Bentall手术+Sun′s手术患者术中的输注量(3.04±4.41)U、(813.48±582.02)mL、(18.39±6.43)U、(1.76±0.58)治疗量比较无差异(P>0.05)。术前Hb行Bentall手术治疗患者(127.75±23.17)g/L及行Sun′s手术治疗患者(126.07±16.14)g/L明显低于行Bentall手术+Sun′s手术治疗患者(133.17±18.12)g/L(P<0.05),术后Hb、APTT以及Plt组间比较无差异(P>0.05)。围术期红细胞大量输注者占53.42%,大量输注组住院天数(23.83±9.74 d)明显高于常规输注组(31.71±22.98 d),大量输注组死亡率34.88%高于常规输注组5.33%(P<0.05),大量输注组出院Hb(95.65±11.58)g/L低于常规输注组(101.93±15.77)g/L(P<0.05)。结论血液输注是保证急性Stanford A型主动脉夹层患者围术期治疗的必要措施,红细胞大量输注伴随死亡率增加,住院时间延长,凝血功能的检测有利于指导血液成分的使用,采用个性化的限制性输血策略可以减少不必要的输血,保障患者安全。