3228例临床用血调查分析及对策探讨  

Investigation and analysis of 3 228 cases of clinical blood transfusion and exploration on countermeasures

作　　者：胡晓燕[1] 王苑[1] 朱鑫方[1] 张琦[1] 夏荣[1] 

机构地区：[1]复旦大学附属华山医院输血科,上海200040

出　　处：《中国输血杂志》2015年第8期942-944,共3页Chinese Journal of Blood Transfusion

基　　金：国家自然科学基金面上项目((81170530)

摘　　要：目的了解临床应用输血指证情况,发现临床输血所存在的问题,进一步规范安全、有效、合理用血。方法收集2013年我院住院患者的输血病例,统计各种血液制品使用情况及输血指证应用不合理情况。结果 3 228份病例中输注红细胞、冰冻血浆、血小板和冷沉淀不合理使用的比例分别为14.9%,29.1%,4.7%,28.5%。其中血小板合理使用情况最好,冰冻血浆和冷沉淀不合理使用情况比较严重。除冷沉淀外,外科不合理用血情况普遍比内科严重。红细胞、冰冻血浆、血小板使用不合理主要是超输血指证输血,冰冻血浆输血前无评估比例最高,达19.2%。冷沉淀不合理使用主要是符合输血指证但输注剂量不足,内科高达55.2%,外科35.4%。结论部分临床医生凭经验用血,对输血指证仍未引起足够的重视,其中血浆和冷沉淀不合理输血现象较严重。在符合输血指证的情况下对输注剂量的判断也存在一定问题。还需加强临床合理用血的知识,进一步保障用血供求和输血安全。Objective To investigate the clinical application of transfusion indicators to identify the problems in clinical transfusion and to further standardize the safe, effective and rational transfusion. Methods All transfusion cases of hospitalized patients in 2013 were collected. The unreasonable usage of transfusion indicators and components for transfusion were counted. Results The proportion of unreasonable transfusion of erythrocyte, plasma, cryoprecipitate and platelet in all 3 228 cases were 14.9%, 29. 1%, 28.5% and 4. 7%. The reasonable transfusion of platelet was best and the unreasonable transfusion of plasma and cryoprecipitate was particularly concerning. Except cryoprecipitate, the phenomenon of unreasonable transfusion in surgery department was more concerning than internal medicine department. The lack of transfusion indicators was the main reason for t^nreasonable transfusion of erythrocytes, plasma and platelet. The proportion of plasma for transfusion which lacked assessment before transfusion was highest at 19. 2%. Unreasonable transfusion of cryoprecipitate mainly attributed to insufficient infusion dosage despite having transfusion indicators. This proportion occupied up to 55.2% in internal medicine department and 35.4% in surgery department. Conclusion Some chnical doctors still determine blood use with their experience, which did not cause enough attention on the usage of transfusion indicators. The unreasonable phenomenon of plasma and cryoprecipitate was more worthy of concern. There were some problems in the judgment of infusion dose. The knowledge on reasonable clinical usage of blood shows need to strengthen and to further ensure the safety of transfusion and blood supply.

关 键 词：输血指证 合理用血 成分输血 

分 类 号：R457.1[医药卫生—治疗学]