病历质控系统在输血病历中的应用

目的通过输血病历评价系统评价全院输血病例,并通过病历质量控制系统监控输血病例,以期全面改进输血病历水平。方法根据《北京地区医院管理考核评价标准实施细则(2009版)》《病历书写规范》《输血技术规范》等相关要求,对输血病历进行评价。通过病历质控系统调取2015—2020年共21 790份临床输血病历,其中非手术科室5 515份,手术科室16 275份(实际用血病历4 134份)。采用输血评价系统对每一份病历问题进行登记分类和汇总,通过扣分制与绩效相关联,同时实时反馈并发布《输血月报》公示,对出现的共性问题输血病程遗漏、输血后评价未完成、知情同意书缺项等问题,通过电子病历质控系统进行提示或强制限制,未完成者禁止再次申请用血和禁止出院结算等方式,彻底对输血病历进行了全面全流程的监管。结果 2015—2020年合格病历呈逐年上升趋势,每年较前一年增加(P0.05)。非手术科室的输血病历合格率(96.33%)高于手术科室(88.90%),2020年病历质控系统干预后比前5年有大幅进步(P0.01)。结论通过信息系统对输血病历进行全流程的监管,临床输血病历质量得到有效地提高。     

输血质控督查问题及解决对策

目的 通过抽查输血病案,发现临床输血管理不规范行为,探索解决方案。方法 对2017年1月~2018年12月我院输血科和医务处抽检的720份输血病案进行督查,按照我院《临床用血管理考核实施细则》进行考核,包括输血标本的采集、交叉配血是否符合要求、输血前评估、输血申请审核、大量用血审批、输血治疗知情同意书、输血前感染性标志物检测、血液交接、血液运输冷链管理、输血过程监控、不良反应回报等。结果 存在缺陷的输血病案共182份,占受检总数25.28%;缺陷病历排名前5位分别为输血申请不规范（64例）、输血后疗效评价欠缺（44例）、输血治疗同意书填写不完整（26例）、输血病程记录不完整（12例）、血液冷链运输不符合要求（8例）,占缺陷病案的84.62%;手术科室输血病案存在问题占缺陷病案总数62.64%,非手术科室缺陷输血病案占37.46%;医生记录的缺陷占缺陷病案总数91.75%,护理人员记录仅占7.02%。结论 我院临床医生记录的输血病案存在问题较多,建议严格按照临床操作技术规范执行,确保输血各个环节质量,以保证患者的用血安全。     

对于手术输血病案质量缺陷与对策分析

目的：探讨手术输血病案质量存在的问题,促进输血病案相关管理工作的规范化,提高医院输血病案的整体质量,保障医疗安全。方法针对医院输血病案制定专门的检查标准,随机抽取本院收集的357份手术输血病案,对其开展质量分析。结果质量控制手术输血病案主要由手术护理记录、麻醉记录、手术记录以及术后首次病程记录这4个方面构成。本次研究的357分手术输血病案中,四项内容均记录完整的占58.8%,存在缺陷的有42.2%,其中术后首次病程记录的缺陷缺最高,高达68.3%。结论医院输血病案的质量直接影响着病案内涵的正确表达,并与医院医疗质量的好坏以及医疗安全性存在密切的关系,医院必须要高度重视输血案例质量管理工作,促进医疗有效性及安全性的提高,尽可能减少医疗纠纷的发生。     

围术期输血对胃癌根治术患者预后及免疫的影响

目的观察围术期输血对胃癌根治术患者的临床效果,分析其对患者预后及机体免疫的影响遥方法回顾性研究2009 年4 月~2012 年11 月收治的100 例胃癌根治术患者,依据围术期有无输血记录,分为两组,即甲组（47 例）与乙组（53 例）,甲组 接受输血,乙组未接受输血,观察分析输血对患者预后及免疫的影响遥结果对于5年生存率,甲组为48.94%,乙组为64.15%,组 间差异具有统计学意义（约0.05）遥经免疫学检测,组间CD3尧CD4尧CD8 以及Leu-7 值无显著差异（跃0.05）,术后3 y,乙组 CD4+/CD8+明显高于甲组,差异具有统计学意义（约0.05）遥结论胃癌根治术围手术期输血患者CD4+/CD8+低于未输血患者, 易引起免疫抑制遥     

成分输血在25例外科手术患者大出血的应用

目的探讨成分输血在抢救外科手术患者手术中大出血的临床疗效。方法回顾性分析25例大量输血手术患者的临床资料,根据患者病情分为择期手术组和急诊手术组,统计分析患者输注红细胞悬液（CRCs）、新鲜冰冻血浆（FFP）、浓缩血小板（PC）和冷沉淀（Cryo）等成分血的种类和剂量以及输注后的不良反应。结果25例大出血患者经成分输血抢救后出血症状均得到控制,并获得良好的疗效;输注量最大的血液品种是红细胞悬液,两组大量输血手术患者手术前、后实验室检查结果比较无显著性差异（P〉0．05）。结论成分输血在外科手术患者手术中大出血时应用可获得良好的止血效果,为手术继续进行提供了很好的机会,但在各种成分血液用量上有很大差异,应根据患者的出血情况和实验室检查结果输注不同的成分血液。     

新型电动振荡输血装置输注血小板临床效果观察

目的 通过观察采用新型电动振荡输血装置输注血小板的临床效果,为科学、合理、有效地输注血小板提供参考依据。方法 选取2015年5月~2016年8月我院80例需输注血小板的患者,随机分为对照组与实验组,各40例。实验组患者使用新型电动振荡输血装置输血,对照组患者未使用新型电动振荡输血装置输血,观察两组的输血效果。结果 输血前,两组血小板含量比较,差异无统计学意义（P＞0.05）;输血后,实验组血小板含量高于对照组,差异有统计学意义（P＜0.05）;实验组输血前后血小板含量差值高于对照组,差异有统计学意义（P＜0.05）。结论 采用新型电动振荡输血装置输注血小板的疗效更好。     

地中海贫血患儿输血后血清促红细胞生成素变化

目的检测地中海贫血（地贫）患儿长期输血治疗后血清促红细胞生成素（EPO）含量,探讨其临床价值。方法应用酶联法（ELISA）检测8例长期输血重型β-地贫患儿输血前后血清EPO含量,15例轻度地贫和40例健康对照组儿童血EPO含量。结果重型β-地贫患儿EPO含量明显增高（P〈0.001）,输血前后EPO含量差异无统学意义（P〉0.05）,轻度地贫患儿与健康对照组EPO含量差异无统计学意义（P〉0.05）。结论长期输血重型β-地贫患儿EPO含量增高显著,输血治疗对EPO无影响,轻度地贫患儿EPO含量与健康儿童无差异。     

悬浮红细胞联合手工分冰冻血浆输注对大量输血患者 凝血四项指标变化的影响

目的 探究悬浮红细胞联合手工分冰冻血浆输注对大量输血患者凝血四项指标变化的影响。方法 选取2013年9月～2017年4月我院58例大量输血患者,依据输血方式不同分组,各29例。对照组输入悬浮红细胞,于此基础上,实验组输入手工分冰冻血浆。对比两组大量输血前及输血后第1、3、5 天凝血四项指标水平。结果 输血前,两组凝血四项指标FIB、TT、APTT、PT水平相比,差异无统计学意义（P＞0.05）;输血后第1天,两组FIB水平较输血前下降,TT、APTT、PT水平较输血前上升,差异有统计学意义（P＜0.05）;输血后第3 、5天,两组FIB水平较输血后第1天上升,TT、APTT、PT水平较输血后1 d下降,差异有统计学意义（P＜0.05）;输血后第5天,实验组凝血四项指标FIB、TT、APTT、PT水平均基本恢复至输血前水平,差异有统计学意义（P＞0.05）;且输血后第1、3、5天 ,实验组FIB水平较对照组高,TT、APTT、PT水平均较对照组低,差异有统计学意义（P＜0.05）。结论 对大量输血患者联合输注悬浮红细胞、手工分冰冻血浆,有助于改善凝血功能,提高输血疗效,在临床治疗中具有重要意义。     

县级中医院临床护士睡眠质量影响因素及解决对策

目的 调查本院各科室临床护士睡眠质量及其影响因素,提供相关防范措施,为改善护士睡眠质量、提高护士身心健康提供理论依据。方法 选取本院各科室106名护士为调查对象,采用PSQI和一般情况调查表对护士的睡眠状况进行调查,分析调查结果,提出相关对策。结果 全院106名临床护士PSQI得分＞7分者共18人（16.98%）,其余护士PSQI得分≤7分。各科室之间比较,PSQI得分＞7分发生率最高的是血透室66.67%,其次为内科32.00%、妇产科27.78%、ICU室和急诊22.22%、手术室20.00%、外科17.24%最低。各科室临床护士睡眠时间比较,差异有统计学意义（P＜0.05）;年龄、学历、婚姻对临床护士睡眠质量无影响（P＞0.05）,班制对临床护士的睡眠质量有影响（P＜0.05）。ESS调查结果显示各科室临床护士嗜睡指数比较,差异无统计学意义（P＞0.05）;但从表观数据可以看出,所有科室临床护士的嗜睡指数均＞7分,血透室护士嗜睡指数最高,达到了（9.45±1.67）分。结论 各个科室护士睡眠质量均较差,医院应针对具体情况,作出针对性的干预措施,提高护士整体睡眠水平。     

稀释性自身输血在择期手术中的类试验研究

目的探讨稀释性自身输血在择期手术中的可行性和安全性。方法选取2003—2006年菏泽市立医院46例稀释性自身输血患者为实验组，随机抽取50例异体输血患者为对照组，观察病人血气分析指标和血液指标，数据用SPSS11．0软件对数据进行t检验和配对t检验。结果稀释性自身输血和异体输血病人术前血红蛋白水平差异无统计学意义（P〉0．05）；输血30min后与麻醉前PH、PaO2、PaCO2、SB、BE的变化水平均无明显差异（P〉0．05）；术后第1天与术前HCT、HGB、PLT、PT的变化水平均无明显差异（P〉0．05）。结论稀释性自体输血是一项安全、简便、有效的临床治疗手段，可以应用于择期手术。     

120例急性输血反应的临床分析

目的通过对120例急性输血反应发生的情况及其预防、处理方式进行总结分析．为临床减少输血反应、有效处理输血反应提供参考。方法统计分析我院2007年1月至2008年12月各类血液成分的输血反应情况;比较输血前常规用药是否能预防输血反应的发生i并通过对120例输血反应的处理进行分析,总结较为安全有效的处理方式。结果总的输血反应率为2．0％,各类血液成分输血反应率有一定区别．差异有统计学意义（x2=12．54,P〈0．05）;输血前用药组与非用药组比较,其输血反应发生率无统计学意义（X2=0．096,0．11,0．015,0．342,P〉0．5）;地塞米松、冰敷、121服百服宁等对治疗非溶血性发热性输血反应（febrilenon—hemolytictransfusionreactions,FNHTR）有效,非那根对治疗FNHTR无效,地塞米松、非那根及扑尔敏等抗组胺药对过敏反应有效。结论输血前用药预防输血反应的作用不明显;非那根等抗组胺药对治疗FNHTR无效。明确输血反应的种类并对症治疗,是处理输血反应的有效手段。     

Blood transfusion services in the countries that joined EU in the last years: Poland

The activity of Polish Blood Transfusion Service (BTS) is based on the Public Blood Transfusion Service Act voted by the Polish Parliament. There are 21 regional blood transfusion centers, one military blood transfusion center and one blood transfusion center (BTC) of the Ministry of Internal Affairs. The Institute of Haematology and Transfusion Medicine (IHTM) is responsible for issuing guidelines for blood transfusion medicine. All BTCs must have an accreditation from the Ministry of Health. In Poland, there is a national system of haemovigilance. Hospitals are obliged to immediately report all post‐transfusion complications and ‘near‐miss’ events. Immunological, viral, bacterial as well as transfusion‐related acute lung injury reactions are supervised by IHTM. Qualification improvement and training of personnel is one of the priorities of Polish BTS.     

Effect of exchange blood transfusion on some indices of skeletal muscle metabolism

After replacement of 85% of the blood volume in healthy dogs and also in animals with transfusion shock the content of the nitrogenous fractions and activity of aspartate and alanine aminotransferases in the skeletal muscles were studied for 7 days. The exchange blood transfusion produced a good therapeutic effect on the animals with transfusion shock. However, the process of flushing of nonprotein substances from the tissues of these animals was much less complete than in healthy animals.Experimental Division, Institute of Hematology and Blood Transfusion, L'vov. (Presented by Academician of the Academy of Medical Sciences of the USSR A. M. Chernukh.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 82, No. 12, pp. 1423–1424, December, 1976.     

Liver function after massive transfusions of packed red cells

The liver function was studied in 16 dogs after experimental transfusion of massive doses of packed red cells in order to identify which component of the blood influences the liver function. Transfusion of massive doses of packed red cells was found not to cause any significant changes in the excretory, assimilative, and protein-forming functions or in the content of transaminases. In the control group receiving transfusions of massive doses of whole homologous blood considerable disturbances of liver function were found. The results confirm the view that one cause of disturbances of liver function in the massive blood transfusion syndrome is incompatibility of the plasma proteins of the donor and recipient.Pathophysiological Laboratory, Central Institute of Hematology and Blood Transfusion, Ministry of Health of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR N. A. Fedorov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 86, No. 8, pp. 159–161, August, 1978.     

The impact of training in transfusion medicine

Background Basic training skills and program for all health care providers working in the blood transfusion services is important and essential. All blood transfusion staff should have active participation in a training program that includes teaching all national and international regulations related to blood transfusion administration and guidelines of safe blood and blood products. The blood bank staff (physicians, medical technologists and nurses) should pass proper assessment procedures in order to work in this vita health related services. All staff working in blood transfusion services should receive a proper education and learning skills in this field of medicine. Awareness of blood safety and Good Manufacturing Practice (GMP) in blood transfusion should be greatly increased among them. Methods and Results Sustainable national and international education and training in blood transfusion services are needed and should be considered as a priority. Methods of teaching and training may include courses or workshops consist of a series of lectures, practical sessions, problem based learning and computer based distance learning programs. A proper training and continuous medical education in blood transfusion services have played an important role in minimizing the risk of transfusion related complications in many countries. Conclusions Creating an effective learning and training environment is a real challenge for most developing countries. Transfusion medicine is a branch of medicine which has a great link with almost all medical and surgical specialties. Blood transfusion safety plays an important and significant role in the patient's management. Proper qualified training personnel are the key of delivering safe blood components and the Good Manufacturing Practice (GMP) in blood transfusion services.     

An audit to estimate the quality of practices followed during bedside blood transfusion in a tertiary care hospital and role of continuous medical education in it

Blood transfusion is an integral component of the health Service system and it becomes imperative that its benefits, risks as well as prospective and viable alternatives of this common medical intervention are explained explicitly to the patients. Appropriate compliance to bedside blood transfusion practices can also help in avoiding adverse transfusion outcomes. At the same time, it is also crucial to document a patient's valid consent based on their decision after evaluation of the risk to benefit ratio. This audit aims to assess the compliance and adherence to bedside blood transfusion practices in a tertiary care hospital and role of Continuous Medical education (CME) on it. The study involved collection of data for blood transfusion services and practices in two periods, for adults and children, who received transfusion from the month of June 2021 to October 2021 and a re-audit beginning from November 2021 to February 2022 following few CMEs in between involving doctors and nurses. A total of 3240 transfusion procedures were assessed in this duration. In them 1500 (46.3%) took place before CME and remaining 1740 (53.7%) procedures took place after CME. There were statistically significant differences between pre-CME and post-CME bedside transfusion practices. During CME/training session, pre-training and post training knowledge has been evaluated by test which also showed statistically significant difference in knowledge of transfusion medicine & bedside transfusion practices. Our study recommends that there is a need of frequent audit on bedside transfusion practices to check the quality and standards associated with it and also points out the need of continuous medical education on this issue.     

New guideline for transfusion medicine

The New Guideline for Transfusion Practice (TP) and the New Criteria for Indication of Blood Products for Transfusion (BPfT) were revised in September 2005. Both are based on the New Blood Law approved in July 2003, which defines the principles of TP and determines the responsibility of the related parties. The New Blood Law and the revised guidelines require safe and appropriate TP; namely, avoid mismatched transfusion, determine indication appropriately and supply sufficiently safe blood products to cover the domestic demand. The New Guideline for TP defines the essential points of the hospital management system for appropriate TP. The establishment of a practical management system based on active hospital transfusion committee (HTC) advice is essential. The establishment of a transfusion service equipped for laboratory testing and unification of the management system of TP; a medical doctor responsible for TP with full commitment to transfusion management, a transfusion manual, specialized laboratory technicians and a 24-hour system for transfusion testing and provision are required. Autologous blood transfusion should be recommended as the safest TP, when appropriate management and operation systems are established. The New Criteria for the Indication of BPfT show the summarized criteria for the indication of each blood product at the beginning, and detailed information about each field at the end. Also described are the inappropriate use of each blood product, the trigger level and the objective level of blood components, the timing, dosage and rate of transfusion for each product, the transfusion-related record database, and the evaluation of transfusion effectiveness from the viewpoint of improvement of the clinical status as well as the laboratory data.     

Évaluation de la traçabilité effective des produits sanguins labiles à partir des dossiers médicaux

The traceability of blood products is an essential part of haemovigilance and transfusion safety. A pilot survey assessed the actual traceability by analysing transfusion information collected from medical records of a representative sample of 390 labile blood products transfused in a French university hospital.Transfusion and distribution forms were missing in 2.3% and 6.9% respectively. Availability and validity of transfusion information varied according to the nature of the expected information, elements of patients' records and types of wards. The location where the transfusion was performed was false or ambiguous in 38% of cases in surgery. Crude traceability, evaluated by the feedback of validated distribution forms, was estimated at 85.2% whereas actual traceability was estimated at 81.9% (SD 1.7%). High availability (98.7%) of at least one of the two sheets of the distribution form in medical records, or in the blood bank, revealed that a significant improvement of traceability should come from a better compliance to the rules of information transmission. The actual traceability differed significantly according to clinical services (worse in surgery) and was lower in case of autologous or absence of previous transfusion.An analysis of markers of good traceability should suggest efficient evolution of organization and information systems. This pilot study shows the relevance and feasibility of this kind of survey which could interestingly be performed on a large national representative random sample. © 1998 Elsevier, Paris