综合、全程血液管理措施对骨科手术患者异体输血的影响

  目的  回顾分析综合、全程血液管理措施对骨科手术患者异体输血情况的影响。  方法  纳入北京协和医院骨科2013年1月至2014年12月接受骨科手术的7082例患者, 其中2013年3320例, 2014年3762例; 高出血风险手术2013年2178例, 2014年2322例。2014年1月起, 骨科开始全面采取涉及全围术期的自体输血技术、改进手术及围术期治疗技术、药物干预和科学执行输血原则四方面的个体化综合血液管理措施。将2014年异体输血情况与2013年情况进行回顾性比较, 评估新措施对骨科手术患者异体输血的影响。  结果  2013、2014两年度患者性别、年龄、高出血风险手术类型及分布情况类似。2014年总手术量及高出血风险手术量均大于2013年度。2014年所有患者异体总输血量106 950 ml(713例)低于2013年121 600 ml(760例), 异体总输入浓缩红细胞单位数2543 U低于2013年2804 U。2014年异体输血总花费680 720元, 占异体输血患者医疗总费用比例0.97%(680 720元/70 287 242.03元), 占总医疗费用0.35%(680 720元/196 100 485元)均低于2013年(分别为1.04%和0.42%)。2014年平均住院日(12.46 d比12.90 d)和并发症发生率(2.02%比5.03%)均低于2013年。  结论  通过执行全面、科学的综合血液管理措施, 可以在保障患者医疗安全、保持高效医疗服务能力的同时, 减少骨科手术患者的异体输血量。

Effect of Comprehensive and Whole Process Blood Management on Allogeneic Transfusion in Orthopedic Surgical Patients

Objective　To retrospectively analyze the effect of comprehensive and whole process blood management on allogeneic transfusion in patients undergoing orthopedic surgery. Methods　A total of 7082 patients (3320 in 2013，3762 in 2014) who underwent orthopedic surgery in the period from January 2013 to December 2014 in Department of Orthopedics, Peking Union Medical College Hospital were retrospectively analyzed, among which 2178 cases in 2013 and 2322 cases in 2014 were considered at high hemorrhage risk. Since January 2014, the Department has implemented individualized comprehensive blood management measures covering the whole perioperative period, involving perioperative autologous blood transfusion technology, treatment improvement during surgery and perioperative period, drug intervention, and strict following of blood transfusion principles. We compared the overall conditions of allogeneic blood transfusion in 2014 with those in 2013, assessing the impact of those new management measures on allogeneic blood transfusion in patients who underwent orthopaedic surgery. Results　The differences in gender, age, types and distribution of high hemorrhage risk surgeries were not statistically significant between the two years. However, both the overall number of orthopedic surgeries and the number of surgeries with high hemorrhage risk were larger in 2014 than in 2013. The total volume of allogeneic blood transfusion in 2014 was 106 950 ml (713 cases), lower than the volume in 2013 (121 600 ml, 760 cases). Similarly, the total amount of transfused concentrated red blood cells in 2014 (2543 U) was less than that in 2013(2804 U). ]The expense on allogeneic transfusion was 680 720 RMB in 2014, accounting for 0.97% of the total medical expenses (70 287 242.03 RMB) of the patients receiving allogeneic blood transfusion and 0.35% of the overall medical expenses (196 100 485 RMB), which were all lower than the corresponding figures in 2013(1.04% and 0.42%, respectively). Moreover, the average length of hospital stay in 2014 was lower than that in 2013 (12.46 d vs. 12.90 d), as well as the incidence rate of complications (2.02% vs. 5.03%). Conclusion　In addition to ensuring safe healthcare and efficient medical service, comprehensive and whole process blood management could reduce the volume of allogeneic blood transfusion in patients undergoing orthopedic surgeries.