肝移植患者围术期PBM的建立与实施  

Perioperative PBM in liver transplant patients:establishment and implementation

作　　者：侯星羽 秦雯[1] 海帆 李兵[2] 普丽[1] 宋松涛[1] 陈刚[3] 徐荣华[1] HOU Xingyu;QIN Wen;HAI Fan;LI Bing;PU Li;SONG Songtao;CHEN Gang;XU Ronghua(Blood Transfusion Department,Kunming First People's Hospital,Kunming 650011,China;Anesthesiology Department,Kunming First People's Hospital,Kunming 650011,China;Hepatobiliary Pancreatology Department,Kunming First People's Hospital,Kunming 650011,China)

机构地区：[1]昆明市第一人民医院输血科,云南昆明650011 [2]昆明市第一人民医院麻醉科,云南昆明650011 [3]昆明市第一人民医院肝胆胰科,云南昆明650011

出　　处：《中国输血杂志》2023年第11期999-1004,共6页Chinese Journal of Blood Transfusion

基　　金：云南省器官移植临床医学中心开放课题(ZX2019-07-01/2020SYZ-Z-039)。

摘　　要：目的建立切实可行的临床肝移植患者血液管理(PBM)模式,以优化肝移植围术期用血量,改善患者预后与生存率。方法成立多学科PBM团队,初期由医务部牵头,采用问卷调查法对在临床建立肝移植患者PBM模式的重要性向麻醉科、肝胆科、输血科、ICU医务部等相关科室近71人做了《器官移植患者血液管理模式的建立与实施》的问卷调查,经过统计分析,确定肝移植患者PBM的重要项,制定试行方案,包括医务部组织,输血科负责对麻醉科、肝胆科、ICU等科室的医护人员完成教育培训后,麻醉科、肝胆胰科、ICU确定肝移植患者术前、中、术后PBM措施,以2021年本院的肝移植患者30人为实验组(对象),全面实施PBM;同时选取2020年本院所做的肝移植术30例为对照组,比较2组患者的一般情况、术前实验室检查结果以及术前、中、后输血情况。结果实验组与对照组比较,术前均未输注任何成分血;术中异体成分血输注量:红细胞(U)为12.75(8.75,18.63)vs 15.25(8.38,26.13)(P>0.05),单采血小板(治疗量)为0(0,2)vs 1(0,4.25)(P>0.05),血浆(U)为2300(1550,3763)vs 3650(2075,5400)(P<0.05];冷沉淀(U)0(0,10)vs 10(0,30)(P<0.05);术后异体成分血输注量:红细胞(U)为8.00(3.38,12.88)vs 11.25(4.75,19.63)(P>0.05],单采血小板未输注,血浆(U)为0(0,0)vs 0(0,600)(P>0.05],冷沉淀未输注。结论肝移植患者PBM模式的建立及其管理措施在移植术前、中、后的运用,明显减少了患者术中输血量,改善患者移植术后的预后。Objective To establish a practical and feasible blood management(PBM)model for clinical liver transplant patients,so as to optimize the perioperative blood usage and improve patient prognosis and survival rate.Methods Led by the Medical Department,a questionnaire survey Establishment and Implementation of a Blood Management Model for Organ Transplant Patients on the importance of establishing a PBM model for liver transplant patients in clinical practice was conducted among 71 staff from relevant departments such as the Anesthesiology Department,Hepatobiliary Department,Blood Transfusion Department,and ICU Medical Department.After statistical analysis,the important items of PBM for liver transplant patients were determined,and a(trial)plan was organized by the Medical Department and training was conducted by Blood Transfusion Department for medical staff training from departments as Anesthesiology,Hepatobiliary and Pancreatology,and ICU;PBM measures for liver transplant patients before,during and after surgery were determined by the Anesthesiology Department,Hepatobiliary and Pancreatic Department,and ICU;PBM was fully implemented in the experimental group with liver transplant patients in our hospital in 2021 as subjects;30 cases of liver transplantation performed in our hospital in 2020 were selected as the control group,and the general data,preoperative laboratory examination results,and preoperative,intraoperative,and postoperative blood transfusion of the two groups of patients were compared.Results Compared with the control group,the experimental group did not receive any blood component transfusion before surgery.Intraoperative blood transfusion volume of allogeneic components:red blood cells(U)were 12.75(8.75,18.63)vs 15.25(8.38,26.13)(P>0.05),apheresis platelet(treatment volume)was 0(0,2)vs 1(0,4.25)(P>0.05),plasma(U)was 2300(1550,3763)vs 3650(2075,5400)(P<0.05);cryoprecipitate(U)was 0(0,10)vs 10(0,30)(P<0.05);Post-operative blood transfusion volume of allogeneic components were as follows:red blood cell

关 键 词：患者血液管理 肝移植术 用血量 围术期输血 

分 类 号：R457.1[医药卫生—治疗学] R617[医药卫生—临床医学]