患者血液管理在复杂成人心胸外科手术应用分析  

Patient blood management:application in complicated adult cardiothoracic surgery

作　　者：侯忱 龚繁 刘红波 蒋以植 王靖[1] 司宇 周娜 汤朝晖[1] HOU Chen;GONG Fan;LIU Hongbo;JIANG Yizhi;WANG Jing;SI Yu;ZHOU Na;TANG Zhaohui(Blood Transfusion Department,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院输血科,上海200092

出　　处：《中国输血杂志》2021年第2期139-142,共4页Chinese Journal of Blood Transfusion

摘　　要：目的评价多学科合作的患者血液管理(PBM)应用于成人心胸外科Ⅲ~Ⅳ级手术患者围术期输血的效果。方法利用医院信息管理系统(HIS)与输血科管理系统收集本院心胸外科在成人Ⅲ~Ⅳ级手术中启用以患者为中心的患者血液管理(patient blood management,PBM)前后(2016年1月~2018年12月)围术期输血患者的输血数据及其相关临床资料,其中2016年度933例设为PBM引入前按传统输血理念和方法的对照组,2017年度1 139例设为PBM(2017年1月1日启用)初步改进组,2018年1~12月1 411例设为PBM持续改进组;采用χ2检验与方差分析比较3组患者围术期自体输血率、异体输血率、住院时间及住院费用。结果对照组、PBM初步改进组与PBM持续改进组比较:1)术前使用铁剂与EPO纠正贫血的患者比例分别为15.12%(44/291)vs 19.73%(72/365)vs 26.65%(125/469)(P<0.01),10.31%(30/291)vs 12.33%(40/365)vs 15.57%(73/469)(P<0.05)。2)自体输血率分别为57.98%(541/933)vs 44.76%(544/1 139)vs 37.00%(522/1 411)(P<0.01),人均自体输血量(U)分别为351.91±35.85 vs 392.76±43.33 vs 421.75±73.84(P<0.05);异体血输血率分别为18.11%(169/933)vs 17.56%(200/1 139)vs 13.32%(188/1 411)(P<0.01),人均异体输血量(U)分别为6.56±8.33 vs 5.52±6.28 vs 5.56±6.17(P<0.01)。3)人均住院天数(d)与住ICU时间(d)分别为19.54±16.56 vs 16.46±12.06 vs 15.11±10.18,4.45±9.31 vs 3.56±6.93 vs 3.26±5.29(P<0.05);人均住院费用(万元/人)分别为10.76±8.39 vs 9.58±7.58 vs 9.13±5.9(P<0.05)。结论 PBM应用于成人心胸外科Ⅲ~Ⅳ级手术围术期输血后明显降低了患者的自体及异体输血率,以及住院天数和住院费用。Objective To evaluate the effect of multi-disciplinary patient blood management(PBM) on perioperative blood transfusion in patients with cardiothoracic surgery of gradeⅢ~Ⅳ. Methods The blood transfusion data and relevant clinical information of adult patients underwent grade Ⅲ~Ⅳ cardiothoracic surgeries before and after PBM(from January 2016 to December 2018)in our hospital were collected using Hospital Information System and Management System of Blood Transfusion Department. Patients were grouped according to three separate12-month periods:933 cases subjected to conventional blood transfusion practice from Jan. to Dec.2016 as the control group,1 139 cases experienced initial implement PBM(started on Jan.1,2017)from Jan. to Dec.2017 as the early PBM group, and 1 411 cases received improved PBM from Jan. to Dec.2018 as the improved PBM group. The perioperative autotransfusion rate, allogeneic transfusion rate, length of hospital stay and hospitalization expenses of the three groups were compared by χ2 test and variance analysis.Results The comparison results among control group, early PBM group and improved PBM group were as following: 1) The proportion of patients using iron and EPO to treat preoperative anemia were 15.12%(44/291)vs 19.73%(72/365)vs 26.65%(125/469)(P<0.01) and 10.31%(30/291)vs 12.33%(40/365)vs 15.57%(73/469)(P<0.05),respectively. 2) The incidence of autotransfusion were 57.98%(541/933)vs 44.76%(544/1 139)vs 37.00%(522/1 411)(P<0.01).The allogeneic transfusion volume per capita(U) were 351.91±35.85 vs 392.76±43.33 vs 421.75±73.84(P<0.05). The incidence of allogeneic blood transfusion were 18.11%(169/933)vs 17.56%(200/1 139)vs 13.32%(188/1 411)(P<0.01).The allogeneic blood transfusion volume per capita(U) were 6.56±8.33 vs 5.52±6.28 vs 5.56±6.17(P<0.01). 3) The per capita hospital stay(d) and ICU stay(d) were19.54±16.56 vs 16.46±12.06 vs 15.11±10.18 and 4.45±9.31 vs 3.56±6.93 vs 3.26±5.29(P<0.05),respectively. The per capita hospitalization expenses(ten thousand yuan/person) we

关 键 词：患者血液管理 心胸外科手术 围手术期输血 纠正贫血 自体输血 住院天数 住院费用 

分 类 号：R457.1[医药卫生—治疗学] R655[医药卫生—临床医学]