摘要
目的探讨大剂量输血标准培训对患者输血量和存活率的影响。方法选择2014年1月至2023年12月于汉中市12家医院(三级医院3家、二级医院6家、妇幼专科医院3家)外科和产科24 h内输注红细胞制剂≥18 U的314例住院患者为研究对象。这些医院输血科、外科、产科输血相关关键工作人员均于2014—2023年接受《大量输血指导方案》强化培训,所有参训人员考核合格。根据314例患者接受输血时,所在医院关键工作人员接受强化培训程度,将其分为研究组(n=125,关键工作人员强化培训时间≥4年)和对照组(n=189,关键工作人员强化培训时间<4年)。研究组中,男性为78例,女性为47例,年龄为(46.2±15.6)岁,三级、二级、妇幼专科医院患者分别为62、48、15例;对照组中,男性为108例,女性为81例,年龄为(45.7±14.8)岁,三级、二级、妇幼专科医院患者分别为91、81、17例。2组患者的年龄、性别构成比分别比较,差异均无统计学意义(t=0.30,P=0.761;χ^(2)=0.86,P=0.353)。采用回顾性研究方法,利用医院信息系统或实地调阅病例资料,收集2组患者的临床资料,如输血量、输血过程中血常规、凝血功能检测次数,以及患者存活率。2组及3类医院患者定量资料比较采用Mann-Whitney U或Kruskal-Wallis H检验,计数资料比较采用χ^(2)检验或Fisher确切概率法,两两比较的检验水准校正采用Dunn-Bonferroni法或Bonferroni法。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求,并且临床资料收集程序均符合患者收集医院伦理要求。结果①与对照组患者比较,研究组患者的悬浮红细胞输注量下降[24.1 U(11.0,30.9 U)比26.6 U(15.8,34.8 U)],而新鲜冰冻血浆(FFP)[23.9 U(13.7,30.5 U)比11.5 U(6.8,17.9 U)]、血小板[12.5 U(8.1,14.6 U)比4.7 U(3.1,8.9 U)]、冷沉淀[11.2 U(6.5,18.1 U)比4.1 U(2.2,8.9 U)]输注量,以及血常规[4次(2,5次)比2次(1,4次)]、凝血功能[3次(1,6次)比1次(0,3次)]检测次数均升高,差异均有统计学意义(Z=5.12、7.95、8.55、8.89、9.55、13.70,均为P<0.001);并且以上指标在本研究三级、二级、妇幼专科医院患者中,均存在相同趋势(均为P<0.001)。研究组中,3类医院患者的悬浮红细胞、FFP、血小板、冷沉淀输注量及血常规、凝血功能检测次数分别比较,差异均无统计学意义(均为P>0.05)。对照组中,妇幼专科医院患者(n=17)的悬浮红细胞输注量最高;三级医院患者(n=91)FFP、血小板、冷沉淀输注量及血常规和凝血因子检测次数最高(3类医院及两两比较,均为P<0.05)。②研究组患者的存活率为85.6%(107/125),高于对照组的68.3%(129/189),并且差异有统计学意义(χ^(2)=12.13,P<0.001)。研究组三级医院、二级医院、妇幼专科医院患者的存活率,分别高于对照组患者,并且差异均有统计学意义(均为P<0.05)。对照组3类医院患者中,三级医院患者存活率最高,为74.7%(68/91),并且3类医院总体比较和两两比较差异均有统计学意义(均为P<0.05)。结论对医院输血相关关键工作人员进行大剂量输血标准强化培训,可促进临床合理用血,提高患者的存活率,节约血液资源具有积极意义。
Objective To explore the effect of standardized training in massive blood transfusion on transfusion volume and survival rate of patients.Methods From January 2014 to December 2023,a total of 314 hospitalized patients who received red blood cell transfusion≥18 U within 24 h in the surgical and obstetric departments of 12 hospitals(including 3 tertiary hospitals,6 secondary hopsitals and 3 maternal and child specialty hospitals)in Hanzhong City were selected as research subjects.Key staff related to blood transfusion of the blood transfusion,surgery,and obstetrics departments of these hospitals received intensive training on the"Massive Blood Transfusion Guidelines"from 2014 to 2023,and all participants passed the assessment.According to the extent to key staff receiving intensive training when these 314 patients received blood transfusion,they were divided into study group(n=125,key staff received intensive training for≥4 years)and control group(n=189,key staff received intensive training for<4 years).In study group,there were 78 males and 47 females,with an age of(46.2±15.6)years old;in control group,there were 108 males and 81 females,with an age of(45.7±14.8)years old.There were 62,48 and 15 patients in tertiary,secondary,as well as maternal and child specialty hospital,respectively,while 91,81 and 17 patients in control group.There was no significant difference in age and gender composition between the two groups(t=0.30,P=0.761;χ^(2)=0.86,P=0.353).A retrospective research method was used to collect clinical data of the two groups of patients,such as transfusion volume,blood routine tests and number of coagulation function tests during transfusion,and patient′survival rate,using the hospital information system or on-site medical record review.Mann-Whitney U or Kruskal-Wallis H test was used to compare the measurement data of patients in the two groups and the 3 kinds of hospitals,and the Chi-square test or Fisher′s exact probability method was used to compare the count data.The Dunn-Bonferroni or Bonferroni method was used to adjust the test level for pairwise comparisons.The procedure followed in this study were in accordance with the requirements of the World Medical Association Declaration of Helsinki revised in 2013,and the clinical data collection procedures were in accordance with the ethical requirements of the patients collection hospital.Results ①Compared with control group,the transfusion volume of suspended red blood cells was reduced[24.1 U(11.0,30.9 U)vs 26.6 U(15.8,34.8 U)]in study group,while the transfusion volume of fresh frozen plasma(FFP)[23.9 U(13.7,30.5 U)vs 11.5 U(6.8,17.9 U)],platelets[12.5 U(8.1,14.6 U)vs 4.7 U(3.1,8.9 U)],and cryoprecipitate[11.2 U(6.5,18.1 U)vs 4.1 U(2.2,8.9 U)]and the number of blood routine tests[4 times(2,5 times)vs 2 times(1,4 times)]and coagulation function tests[3 times(1,6 times)vs 1 time(0,3 times)]were all increased,and the differences were statistically significant(Z=5.12,7.95,8.55,8.89,9.55,13.70,all P<0.001);and the above indicators showed the same trend in patients admitted to tertiary,secondary,as well as maternal and child specialty hospitals in this study(all P<0.001).Among the patients in study group,the transfusion volumes of suspended red blood cells,FFP,platelets,and cryoprecipitate,as well as the test number of blood routine and coagulation function among the 3 kinds of hospitals were compared,and there were no significant differences(all P>0.05).In control group,patients from maternal and child specialty hospitals(n=17)had the highest transfusion volume of suspended red blood cells;patients from tertiary hospitals had the highest transfusion volume of FFP,platelet,and cryoprecipitate and the highest test number of blood routine and coagulation factor(all P<0.05 for all three and pairwise comparisons).The survival rate of the study group was 85.6%(107/125),which was higher than that of 68.3%(129/189)in control group,and the difference was statistically significant(χ^(2)=12.13,P<0.001).In study group,the survival rates of patients in tertiary,secondary,and maternal and child specialty hospitals were higher than those in control group,and the differences were statistically significant(all P<0.05).Conclusions Intensive training on massive blood transfusion standards for blood transfusion-related key staff in hospital had positive significance for clinical rational blood use,improving the survival rate of patients,and saving blood resources.
作者
余辉
黄溪豪
张丹
冯娜
徐强
冯丽娟
Yu Hui;Huang Xihao;Zhang Dan;Feng Na;Xu Qiang;Feng Lijuan(Hanzhong Central Blood Station,Hanzhong 723000,Shaanxi Province,China;Xi′an Central Blood Station,Xi′an 710061,Shaanxi Province,China)
出处
《国际输血及血液学杂志》
2025年第2期161-166,共6页
International Journal of Blood Transfusion and Hematology
基金
西安市科学技术基金项目(23YXYJ0011)。
关键词
输血
血液成分输血
红细胞输注
大剂量输血
标准培训
血小板
凝血功能检测
Blood transfusion
Blood component transfusion
Erythrocyte transfusion
Massive blood transfusion
Standard training
Platelets
Coagulation function detection
作者简介
通信作者:张丹,Email:651962540@qq.com。
