1 036例受血者输血前感染性指标检测结果分析

目的了解患者输血前血液感染性指标的阳性率,探讨其检测的意义。方法对需要输血的患者1036例采用酶联免疫吸附(ELISA)法检测血清中乙型性肝炎病毒标志物(HBsAg)、丙型肝炎病毒抗体(抗HCV-IgG)、梅毒螺旋体抗体、人类免疫缺陷病毒抗体(HIV1+2抗体)。结果HBsAg的阳性率为4.83%,抗HCV-IgG的阳性率为0.87%,梅毒的感染率为0.39%,HIV抗体的阳性率为0%。结论对患者进行输血前感染性指标检测是必要的,它可以避免和预防医护人员的职业感染,也可以避免因输血而引起的医疗纠纷。     

DRGs in Transfusion Medicine and Hemotherapy in Germany

Patients requiring transfusion medicine and hemotherapy in an inpatient setting are incorporated into the German Diagnosis Related Groups (G-DRG) system in multiple ways. Different DRGs exist in Major Diagnostic Category 16 for patients that have been admitted for the treatment of a condition from the field of transfusion medicine. However, the reimbursement might be not cost covering for many cases, and efforts have to be intensified to find adequate definitions and prices. We believe that this can only be successful if health service research is intensified in this field. For patients requiring hemotherapy and transfusion medicine concomitant to the treatment of an underlying disease such as cancer, multiple systems exist to increase remuneration, among them the Patient Clinical Complexity Level (PCCL) and complex constellations to induce DRG splits. For direct reimbursement of high cost products, additional remuneration fees (Zusatzentgelte, ZE) are the most important. In addition, expensive innovations not reflected within the DRGs can be reimbursed after application and negotiation of the New Diagnostic and Treatment Methods (Neue Untersuchungs-und Behandlungsmethoden, NUB) system. The NUB system guarantees that medical progress is put rapidly into clinical practice and prevents financial issues from becoming a stumbling block for the use of innovative drugs and methods.     

套管针在肾综合征出血热患者应用中的问题及对策

目的　调查套管针在肾综合征出血热 (HFRS)患者应用中的问题 ,并提出对策。方法　 1)筛选套管针渗血的病例数 ,对渗血者分对照组 (立即拔针 )和实验组 (继续留置常规时间 ) ,记录两组感染与再出血的例数 ,比较差异 ;2 )观察低血压休克期使用套管针的所能达到的最快输液速度 ,进行自身对照 ,常规组 :按常规方法 ,输液器头皮针与套管针相连 ,记录输液滴数 ;改进组 :祛除头皮针输液器乳头直接与套管针相连记录输液滴数 ;3)在拔除套管针的当天 ,对患者进行调查 ,了解患者使用套管针的感受。结果　 1)套管针在HFRS患者应用中出现针眼渗血和休克期输液速度减慢 ,对渗血者处理措施 ,实验组与对照组无显著差异 (P>0 .0 5 ) ;2 )对休克期输液速度减慢的处理 ,改进组较常规组有显著差异 (P <0 .0 1) ;3)HFRS患者认为套管针最主要的缺点是价格偏高。结论　 1)套管针针眼出现渗血 ,无须立即拔除 ,可严密观察 ,按常规时间留置 ;2 )抢救HFRS休克患者时 ,应拔除头皮针 ,套管针与输液器乳头直接相连 ,保证快速的灌注 ;3)护理人员在选择套管针时 ,必须慎重 ,应结合病人实际情况而定。     

舒适护理运用于急诊科临时输液室的探讨

目的探讨急诊科临时输液室的舒适护理模式。方法采用自行设计调查表调查急诊输液患者运用舒适护理的前后各100例对输液环境、护士的技术操作及服务质量的满意度。结果通过改善输液环境、合理安排护士班次、规范操作流程、提高护理人员服务态度等,使病人的总体满意度由71．5％上升到95．5％。结论舒适护理运用于急诊科临时输液室,充实了“以人为本”的整体护理质量。     

The microbiome and transfusion in cancer patients

Our microbiota is determined by many variables including ABO blood groups. The microbiota is not only confined to the gut and skin but is also recoverable from blood of healthy donors.The microbiota shape our immune system through cross reactivity with antigens, the expression of direct molecular patterns, the release of cytokines, the effects on nutrients and micronutrients and even through an interplay with epigenetics. It is likely, therefore, that a donor's microbiota could alter the antigenicity of blood and its components and potentially contribute to transfusion-related immune modulation [TRIM]. It could also potentially transmit infections. The recipient's microbiome contributes, on the other hand, to the tolerance to transfused blood, or to the development of transfusion reactions. Cancer patients are a particularly vulnerable population, often immunosuppressed with a significantly altered microbiota. They are more at risk for transmission of “dormant” bacteria via blood transfusion. Furthermore, chemotherapy and radiation induce mucositis that likely results in significant translocation of gut microbiota and abnormal immune reactions to transfused blood. It is therefore relevant to revisit transfusion thresholds and consider transfusion-saving strategies in cancer patients.     

The Global Application of ISBT 128 in Blood Transfusion

Blood Transfusion is a global activity, both in terms of its widespread application, and because of the need in specific circumstances for blood to move across organizational and national boundaries in its journey from donor to patient.     

60例坐位输液晕厥报告分析

目的 探讨坐位输液晕厥发生的原因与需采取的护理措施。方法 对上海市闵行区中心医院输液室自2012年1月-8月间发生的60例坐位输液晕厥进行统计分类。结果 心理性、低血糖性、药源性、心源性、脑源性、血管迷走性晕厥占比分别为25%、20%、25%、8%、14%、8%。结论 环境、心理、低血糖、药物、输液、疾病是导致坐位输液晕厥发生的主要因素,发生坐位输液晕厥需做好预防措施、观察判断、发作时处理、后期护理及出院指导。     

输血对脑外伤患者术后感染的影响

目的 探讨输血对脑外伤患者术后感染的影响,指导合理输血。方法 选择本院1997年1月~2004年1月525例脑外伤手术患者,其中225例术中输注普通悬浮红细胞,202例输注悬浮去白细胞红细胞,98例未输血。对3组患者术后感染率及输血剂量与感染率的关系进行比较。结果 普通悬浮红细胞输血组术后感染率为11．11％,悬浮去白细胞红细胞输血组术后感染率为3．46％,与普通悬浮红细胞输血组相比差异有显著性（P〈0．01）,与未输血组感染率（2．04％）比较差异无显著性。普通悬浮红细胞输血组患者的输血量与术后感染的发生显著相关（P〈0．01）,而悬浮去白细胞红细胞输血组的输血量与术后感染率的相关性不显著。结论 脑外伤患者术后感染的发生与输血、血液成分及输血量等有关。在保证患者能够耐受手术的情况下,应尽量不输血或少输血,对确需输血的患者,应该输注去白细胞红细胞。     

术中红细胞比容指导输血的临床试点研究

目的:术中通过监测红细胞比容(Hematocrit,HCT)指导输血,观察输血量是否明显地减少,为规范术中输血提供试验依据。方法:选择ASAⅠ-Ⅱ级择期估计失血量≥400ml的手术患者32例,随机分为试验组及对照组,各16例。术中动态监测HCT,试验组HCT<24%后开始输血,对照组按常规方法输血。结果:试验组和对照组输血量/失血量分别为0.0585±0.1605,0.4678±0.3540(P<0.05)。结论:术中HCT指导下输血能明显减少术中用血量。     

Indications for red cell transfusions in pediatric patients

Red cell transfusions are amongst the most common therapeutic procedures in seriously ill children, particularly in the inpatient setting. This is despite the fact that there is no evidence base for most clinical settings, with the exception of patients with hemoglobinopathies, particularly thalassemia and sickle cell anemia. Obviously exsanguinating hemorrhage and life threatening anemia are urgent indications for which no other therapeutic approach is currently available. Most transfusions are, however, given prophylactically to prevent the complications of hypoxia or hemodynamic stability, based upon expert opinion and a faith in the oxygen carrying capacity and beneficial hemodynamic properties of transfused red cells. The question confronting current day pediatric practice is to what extent transfused red cells prevent adverse events, other than in thalassemia and sickle cell anemia, as opposed to causing them. Do transfusions of red cells prevent organ failure, stroke, etc. or not? There is epidemiologic evidence in the adult randomized trial literature that liberal red cell transfusion likely causes more such adverse events than it prevents. The relevance of such studies to children, particularly neonates, is uncertain. Randomized trials in critically ill neonates have yielded little to no evidence that liberal red cell transfusion is beneficial, but the data are not definitive. In critically ill older children the data suggest there is no benefit to liberal red cell transfusion, but the indications for red cell transfusion are uncertain. Most practitioners would agree that combining laboratory data such hemoglobin/hematocrit with clinical indications for transfusions (evidence of end organ hypoxia such as tachycardia, shortness of breath, etc.) is the only viable strategy at present, until more definitive randomized trial data are available.     

生理盐水冲管预防输液药物不良相互作用的研究

目的观察生理盐水冲管在预防静脉输液过程中药物不良相互作用的意义。方法把60例接受静脉输液的急性上呼吸道感染患者随机分为两组,研究组（n=30）在换接药液过程中采用生理盐水冲管;对照组（n：30）按一般输液方法换接药液。观察两组莫菲氏滴管内药物与生理盐水或两种药物在相遇时的外观变化,记录副反应、输液治疗天数和临床疗效,同时调查患者对输液的满意度。结果研究组莫菲氏滴管内药物与生理盐水在相遇时发生外观变化为0,对照组两种药物在相遇时发生外观变化为30．0％,研究组副反应的发生率低于对照组,差异均有统计学意义（P〈0．05）,两组的临床疗效、输液治疗天数差异无统计学意义（P〉0．05）,研究组满意度高于对照组（P〈0.05）。结论在临床换接药液过程中,采取生理盐水冲管的方法,在预防静脉输液过程中药物不良相互作用方面有一定的优点,可在临床上灵活应用。     

主动服务在门诊输液病人中的应用与观察

目的：为门诊输液者提供主动服务,提高对输液工作的满意度。方法：输液前对病人做好护理评估,输液中根据病人的个体差异实施人性化主动服务,输液后及时给予病人健康教育,为病人进一步检查和治疗提供咨询服务。结果：门诊输液者对护士门诊输液工作满意度提高。结论：为门诊输液病人提供输液过程中的主动服务,可提高病人的满意度。     

老年患者输液中护理干预的效果

目的 探讨如何提高老年患者静脉输液的质量.方法 对98例老年患者分组行常规(对照组)和护理干预(干预组)的静脉输液比较,观察2组患者的输液质量.结果 对照组静脉输液一次穿刺成功642例次,占89.04%,组织局部肿胀166例次,占23.02%,拔针部位瘀斑74例次,占10.26%;干预组一次穿刺成功699例次,占95.10%,组织局部肿胀75例次,占10.20%,拔针部位瘀斑33例次,占4.49%,2组比较有显著性差异(P＜0.01);对照组和干预组穿刺疼痛程度比较有显著性差异(P＜0.01).结论 在老年患者静脉输液中进行护理干预可以提高输液质量.     

献血者相关肝炎指标检测与控制研究

检测了山东省四个不同地区２０２５名个体献血者相关肝炎的指标。２０２５名献血中男性８４５名，女性１１８０名，平均年龄３４．６ｙ（１９～４８ｙ）平均献血史为２．８ｙ（１～１２ｙ）。实验结果表明，血清ＡＬＴ异常２５例，阳性率为１．２％（２５／２０２５），抗－ＨＡＶ阳性率为７．９％（１６０／２０２５）ＨＢｓＡｇ的阳性率是０．３％（５／２０２５）ＨＢＶ全套检测有３０５／２０２５名献血者存在乙肝病毒感染指标阳     

Plasma self-sufficiency in Spain

In Spain, plasma obtained from whole blood units and plasmapheresis programmes ensures 42.9 % self-sufficiency in intravenous immunoglobulin and 68.4 % in albumin. Despite the increase in the number of plasmaphereses, it has proved impossible to compensate for the drop in source plasma, caused by the decrease in whole blood donations, and for the increase in intravenous immunoglobulin consumption. This article describes the situation in Spain and the measures required to improve it.