急诊输血指征评分对产科急诊手术输血的影响  

Effect of emergency transfusion scores in detecting blood transfusion needs for parturients underwent emergency obstetric surgery

作　　者：林夏妃 刘德行 许凌懿 朱宇航 张超 朱昭琼 LIN Xiafei;LIU Dexing;XU Lingyi;ZHU Yuhang;ZHANG Chao;ZHU Zhaoqiong(Zunyi Medical University,Zunyi 563000,China;Department of Anesthesiology,Affiliated Hospital of Zunyi Medical College)

机构地区：[1]遵义医科大学附属医院麻醉科,贵州遵义563000 [2]贵州中医药大学第一附属医院

出　　处：《中国输血杂志》2020年第4期339-342,共4页Chinese Journal of Blood Transfusion

基　　金：贵州省社会发展攻关项目(黔科合SY字[2015]3051号);贵州省科技厅联合基金(黔科合LH[2016]7500])。

摘　　要：目的评估急诊输血指征评分(ETS)应用于产科输血的临床效能。方法ETS是1种通过等级评分形式指导急诊手术围术期输血的方法。查阅ETS实施前后遵义医科大学附属医院麻醉科麦迪斯顿手术麻醉系统的麻醉记录,制作并录入2014—2016年共4368名输血患者基本信息、手术信息、输血信息及转归情况等指标的《输血情况调查表》,对产科应用ETS于急诊手术前后共36个月的用血情况做回顾性统计分析。结果1)ETS应用前后本组产科急诊手术输血率为12.32%(240/1947)vs 8.75%(212/2421)(P<0.05);其中高龄产妇急诊输血率为16.09%(47/292)vs 9.29%(41/441)(P<0.05)、红细胞人均输注量(U)为3(2,4)vs 2(2,4)(P<0.05),正常年龄产妇急诊输血率为11.67%(193/1655)vs 7.12%(141/1980)(P<0.05)、红细胞人均输血量无明显变化(P>0.05)。2)ASA分级为Ⅰ—Ⅱ的产科急诊手术患者输血率10.57%(189/1788)vs 7.16%(162/2264)(P<0.05)。结论ETS指导产科急诊手术输血后,产科急诊手术患者的输血率较前明显下降,提示ETS应用提高了产科急诊手术红细胞输注的合理性与临床节约用血效能。Objective To evaluate the clinical efficacy of emergency transfusion score(ETS)in detecting parturients'need for blood transfusion in emergency obstetric surgery.Methods ETS was a method that may guide perioperative blood transfusion for emergency surgery by grading scores.In this study,4368 parturients underwent emergency obstetric surgery in Affiliated Hospital of Zunyi Medical College,from 2014 to 2016,were enrolled.ETS parameters including demographic data,surgery mode,and the prevalence/volume of RBC transfusion were recorded via consulting the Madiston Surgical Anesthesia System of hospital and further sorted out into the fills called Questionnaire Concerning Perioperative Blood Transfusion.The ETS was carried out in July,2015,and its efficacy was assessed and compared between the same period prior to(from Jan.2014 to Jun.2015)and after(from Jul.2015 to Dec.2016)the implement of ETS.Results The prevalence of RBC transfusion in emergency obstetric surgery fell significantly after the implement of ETS[12.32%(240/1947)vs 8.75%(212/2421)](P<0.05),also decreased significantly in advanced maternal age parturients[16.09%(47/292)vs 9.29%(41/441)](P<0.05).The mean RBC transfusion volume per capita was 3(range 2—4)vs.2(range 2—4)as compared between the two periods(P<0.05).The prevalence of RBC transfusion in younger parturients prior to and after ETS was 11.67%(193/1655)vs 7.12%(141/1980)(P<0.05),while mean RBC transfusion volume per capita had no significant changes(P>0.05).2)The prevalence of transfusion in parturients with ASA grade of I—II prior to and after ETS was 10.57%(189/1788)vs 7.16%(162/2264)(P<0.05).Conclusion The emergency obstetric surgery's need for blood transfusion has been prioritized by implementing ETS.ETS may be considered as a useful instrument for preventing inappropriate requests for blood transfusion in emergency obstetric surgery.

关 键 词：急诊输血指征评分 产科输血 红细胞输血 产科急诊手术 合理输血 

分 类 号：R457.1[医药卫生—治疗学] R714.46[医药卫生—临床医学]