围手术期临床用血调查分析推测改进输血治疗指征的必要性

Necessity of improvement in indications of blood transfusion treatment by analysis of blood transfusion in clinic during peri-operative period

摘要:

目的  调查分析手围术期临床输血量和输血率的变化趋势及输血存在的问题，探寻改进围手术期新的输血治疗指征的必要性。方法  评估遵义医学院附属医院临床围手术期接受输血的1 000例患者，分别对围手术期血液制品使用情况及手术前后红细胞压积比（Hct)、红细胞计数（RBC）、血红蛋白（Hb）检查结果进行回顾性分析；观察2006～2009年各种血液制品的使用情况，比较输血前后Hb和RBC的变化，探寻新的输血治疗指征。结果  围手术期全血使用率逐渐下降（6.50%），2006～2009年红细胞使用率为74.60%，血浆使用率为23.30%，血小板为0.04%，自体血使用率为44.70%；全血人均使用量逐渐减少，成分血人均用量逐渐增多，各成分血使用中以红细胞为主；术前Hb平均10 g/dl左右，输血前Hb、RBC及Hct略高于输血后，且输血人群Hb>
7 g/dl的患者占大多数。结论  血液制品使用逐渐合理，输血指征掌握不好，用血问题尚存；输血治疗指征迫切需要改进，其对HB 7～10 g/dl的患者更具有临床意义。

Abstract:

Objective To investigate and analyze variation tendency of volume and rate of blood transfusion and problems in blood transfusion during peri-operative period in clinic. Methods A retrospective analysis of the use of blood products and pre- and post-operative Hct, RBC and Hb was made in 1000 patients from the Affiliated Hospital of Zunyi Medical College who received blood transfusion during peri-operative period. The use of blood products was observed, Hb and RBC were compared before and after blood transfusion between 2006 and 2009. Results The usage rate of whole blood declined during peri-operative period which was 6.50%, while those of blood components increased. The usage rates of RBC, plasma and platelet from 2006 to 2009 were 74.60%, 23.30% and 0.04% respectively. The average preoperative Hb was about 10 g/dl. The patients with Hb above 7 g/dl accounted for more than half of overall blood transfusion patients. Hb, RBC and Hct of the patients before blood transfusion were slightly higher than those after blood transfusion. Conclusions Use of blood products is gradually reasonable, but transfusion indications are not well mastered. So transfusion indications need to be improved urgently, especial for the patients with HB of 7-10 g/dl.