30例输血不良反应的原因分析

目的 通过对我院发生的输血不良反应进行调查分析,以寻找减少不良反应发生的有效措施.方法 通过查阅我院2007年1月至2011年6月期间3455例输血患者的病历和输血反应回报单,对输血不良反应情况进行统计分析.结果 本次调查输血病人3455例,输血不良反应有30例(发生率为0.87％),其中以悬浮红细胞、新鲜冰冻血浆和机采血小板等三种血液成分引起输血反应发生率最高.30例输血不良反应均为非溶性输血反应,包括有发热反应19例、过敏反应9例及全身不适2例,其中1h内发生的有23例,2h内发生的有5例,3h内发生的有2例.结论 坚持科学合理的用血原则,输血前有针对性采取适当措施可有效降低输血不良反应率.     

成分输血在8例肝脏移植术受者中应用的分析

目的探讨成分输血在肝脏移植术中的临床应用价值。方法回顾性分析8例原位肝脏移植术受者的临床资料与检验结果。结果8例肝脏移植术患者术前、术中和术后的血细胞分析及出凝血指标差异均无显著性(P>0.05)。结论尽管肝脏移植术中血液制品的用量有很大个体差异,但仍属于大量或超大量用血。应做好术前、术中及术后的各项检验监测,有针对性地补充和输入不同的成分血液。     

One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database*

ABSTRACT

Objective: Acute coronary syndromes (ACS) are life-threatening disorders requiring intensive medical management or invasive cardiovascular procedures. Limited data exist on the costs and resource utilization associated with ACS.

Methods: This retrospective single-cohort study analyzed administrative claims data from employer-sponsored plans for patients with an ACS hospitalization in 2001–2002. A 1?year follow-up period was used, and patients who were under age 35 or had an ACS diagnosis in the 12 months before the hospitalization were excluded. Costs were reported in 2005 US dollars.

Results: We identified 16?321 patients hospitalized for ACS during the study period. Mean (±?SD) age was 55.6 (±?6.7) years, 66.7% were male, and 46.3% underwent a revascularization procedure during their initial hospital­ization. Mean length of stay for the initial hospitalization was 4.6 days (median: 3.0; IQR: 2.0–5.0), and per-patient expenditures averaged $22?921 (median: $13?960; IQR: $6839–28?588). During the follow-up period, 21% of patients were rehospitalized for ischemic heart disease (IHD), and the cost of rehospitalization averaged $28?637. Additionally, in the year following the inpatient admission, 50% of patients were prescribed antiplatelet or anti­coagulant medications, and 90% of patients were prescribed lipid-lowering, antihypertensive, or anti­arrhythmic medications. IHD-related expenditures after the initial inpatient stay averaged $9425 (median: $2800; IQR: $899–7577); 61% of these costs were due to rehospitalization. Total first-year costs averaged $32?345 (median: $21?653; IQR: $10?642–41?106).

Limitations: Diagnoses could not be verified through medical charts. Payments for Medicare patients were not assessed given our focus on the working-age population.

Conclusions: In this employer-sponsored health plan population, the costs of inpatient and outpatient IHD-related care were high. Future studies should evaluate the impact of improved patient management on post-discharge costs.     

三氧化二砷抗骨髓增生异常综合征骨髓血管新生机制的初步探讨

目的探讨骨髓增生异常综合征(MDS)患者骨髓是否存在血管新生及三氧化二砷(As2O3)的抗血管新生作用。方法①采用CD34单抗免疫组织化学染色法标记骨髓组织血管内皮细胞,盲法计数骨髓微血管密度(MVD)。②采用四甲基偶氮唑蓝方法观察As2O3对A组(HUVEC)及B组(经SKM-1细胞株上清液干预组HUVEC)的增殖抑制效应。结果①MDS患者骨髓微血管密度(MVD)显著高于正常对照组(P<0.01),并且随着病程的进展患者的MVD呈增高趋势(Rs=0.86 133,P<0.05);②As2O3对HUVEC及SKM-1细胞株干预组的作用均表现时间、剂量依赖性的增殖抑制效应(F=10.92,P<0.05);③HUVEC中加入SKM-1上清液共同培养对促进细胞生长有明显作用(P<0.01)。结论①MDS患者存在骨髓微血管密度增高,并与MDS患者的疾病进展正相关,血管新生在MDS的发生发展中起到重要作用;②As2O3以时间-剂量依赖性方式抑制HUVEC细胞的生长;③提示MDS细胞可分泌促进内皮细胞生长的细胞因子,通过旁分泌作用刺激内皮细胞生长。     

Comparison of escitalopram vs. citalopram and venlafaxine in the treatment of major depression in Spain: clinical and economic consequences

Abstract

Study objective:

Population based study to determine the clinical consequences and economic impact of using escitalopram (ESC) vs. citalopram (CIT) and venlafaxine (VEN) in patients who initiate treatment for a new episode of major depression (MD) in real life conditions of outpatient practice.     

输血前不规则抗体检测2500例临床分析

目的 探讨输血前进行不规则抗体检验的临床意义和实际应用价值.方法 对2500例输血患者进行输血前不规则抗体检验.结果 2 500例输血前不规则抗体检查中,出现有15例患者血清中含有不规则抗体,阳性率为0.60％;其中男性0.12％ （3/2 500）、女性0.48％（12/2 500）,女性不规则抗体阳性率明显的高于男性不规则抗体阳性率（x2=7.34,P＜0.05）;主要表现为抗C、抗D、抗E和抗M类型以及非特异性抗体,所占的比例分别为：13.3％、26.7％、20.0％、33.3％、6.7％.不规则抗体阳性输血者输血超敏反应发生率为100.0％,不规则抗体阴性输血者输血超敏反应发生率为0.0％,两组差异有统计学意义（x2=9.28,P ＜0.05）.结论 输血前对患者进行不规则抗体检验能够有效的指导患者进行正确的输血,并能够有效的预防和降低输血超敏反应,确保患者输血过程中的安全.     

南阳地区输血不良反应情况的调查分析

目的：了解南阳地区输血不良反应发生状况,提高临床用血的安全性及合理性。方法调查2010年1月~2014年12月南阳地区15家医疗机构各血液成分使用情况,并进行统计分析。结果15家医院5年间共发生输血反应285例,输血反应发生率<1%;各种血液成分中,以输注悬浮红细胞发生不良反应最多,占50.8%,其次是血浆,占43.9%;所有反应中变态反应最多,占52.9%,发热反应次之,占42.8%。结论采供血机构和临床医疗单位应充分认识输血风险,制订有效预防措施,减少或避免输血不良反应的发生,提倡自体输血,确保用血安全。     

The economic burden of schizophrenia in Canada in 2004

ABSTRACT

Objective: To estimate the financial burden of schizophrenia in Canada in 2004.

Methods: A prevalence-based cost-of-illness (COI) approach was used. The primary sources of information for the study included a review of the published literature, a review of published reports and documents, secondary analysis of administrative datasets, and information collected directly from various federal and provincial government programs and services. The literature review included publications up to April 2005 reported in MedLine, EMBASE and PsychINFO. Where specific information from a province was not available, the method of mean substitution from other provinces was used. Costs incurred by various levels/departments of government were separated into healthcare and non-healthcare costs. Also included in the analysis was the value of lost productivity for premature mortality and morbidity associated with schizophrenia. Sensitivity analysis was used to test major cost assumptions used in the analysis. Where possible, all resource utilization estimates for the financial burden of schizophrenia were obtained for 2004 and are expressed in 2004 Canadian dollars (CAN$).

Results: The estimated number of persons with schizophrenia in Canada in 2004 was 234?305 (95% CI, 136?201–333?402). The direct healthcare and non-healthcare costs were estimated to be CAN$2.02 billion in 2004. There were 374 deaths attributed to schizophrenia. This combined with the high unemployment rate due to schizophrenia resulted in an additional productivity morbidity and mortality loss estimate of CAN$4.83 billion, for a total cost estimate in 2004 of CAN$6.85 billion. By far the largest component of the total cost estimate was for productivity losses associated with morbidity in schizophrenia (70% of total costs) and the results showed that total cost estimates were most sensitive to alternative assumptions regarding the additional unemployment due to schizophrenia in Canada.

Conclusions: Despite significant improvements in the past decade in pharmacotherapy, programs and services available for patients with schizophrenia, the economic burden of schizophrenia in Canada remains high. The most significant factor affecting the cost of schizophrenia in Canada is lost productivity due to morbidity. Programs targeted at improving patient symptoms and functioning to increase workforce participation has the potential to make a significant contribution in reducing the cost of this severe mental illness in Canada.     

外周动静脉同步换血治疗新生儿高胆红素血症的护理

目的探讨新生儿高胆红素血症经外周动静脉同步换血的临床效果和护理方法。方法对47例新生儿高胆红素血症患儿采用套管留置针进行外周动静脉同步换血,术前做好环境、物品及病人的准备;术中严格无菌操作,控制好同步换血的速度;术后注意保暖,观察有无电解质紊乱及胆红素反跳的现象。结果47例患儿顺利安全完成换血治疗,换血前后胆红素变化差异有显著性（P〈0．05）,该换血方法提高了换血效果,能维持换血过程中血液内环境的稳定,防止血液动力学变化所引起的并发症。结论外周动静脉同步换血是治疗新生儿重症高胆红素血症效果显著、安全可靠、简单易行的方法。     

自体血液急性稀释输血临床应用体会

目的探讨自体输血的方法,避免输血引起的疾病传播及输注异体血引起的输血反应。方法对38例择期外科手术的患者进行自体血液急性稀释性自身输血。结果自体血液稀释的患者血液稀释前后Hb、RBC、Hct、PLT、TP各项指标,差异无显著性(P>0.05)。结论自体血液急性稀释性输血方法可行,既为手术的顺利进行提供了保障,又大量节约了库血。适用于临床手术输血,方便易操作,值得推广。     

计算机信息系统在输血科管理中的应用

目的 为了不断适应输血医学的改革和发展,积极探索安全、科学的输血管理模式,强化工作人员对输血科工作流程的执行,实现临床输血管理过程控制,提高临床输血的安全性.方法 引进的系统采用C/S结构,PB8.0开发工具,基于Windows2000(高级服务器版)、0RACLE8i(企业版)数据库的运行环境,开发"血库管理信息系统...     

受血者输血前三项检测的临床价值研究

目的探讨受血者输血前三项检测在输血前的临床意义。方法采用酶联免疫法检测3752例受血者输血前三项,并分析其检测结果。结果3752例标本中抗-HIV全部阴性,抗HCV阳性率为0.68%,梅毒阳性率为0.56%。结论受血者输血前三项的检测是明确诊断,预防医患之间交叉感染和减少医疗纠纷的重要措施。     

输血科实习生沟通能力的培养

随着患者和家属对医疗知识的了解和维权意识的增强,医患关系日趋紧张,医疗纠纷日渐增多.据报道,80％～90％的医疗事件其实并不构成医疗事故或医疗过失,只是沟通不够或不当所造成.沟通能力是现阶段医疗背景下医学生需要掌握的基本技能,笔者结合多年输血教学实践,针对输血医学自身特点及实习生沟通能力现状,提出实习生沟通能力培养的重要性及有效的策略.     

Economic impact of generic substitution of lamotrigine: projected costs in the US using findings in a Canadian setting

ABSTRACT

Background: Generic substitution may not always save health care costs for antiepileptic drugs (AED).

Objective: (1) To examine the economic impacts of generic substitution of lamotrigine in Canada; and (2) to convert observed Canadian costs to a United States (US) setting.

Methods: Health claims from Québec's health plan (RAMQ) between 08/2002 and 07/2006 were analyzed. Patients with ≥ 1 epilepsy claim and treated with branded lamotrigine (Lamictal) before generic entry were selected. Health care costs ($/person-year) were compared during periods of branded and generic use of lamotrigine. Two cost-conversion methods were employed; one using purchasing power parities, US/Canada service use ratios, and exchange rate, and another employing Canadian health care utilization and US unit costs.

Results: 671 patients were observed during 1650.9 and 291.2 person-years of branded and generic use of lamotrigine, respectively. The generic-use period was associated with an increase in overall costs (2006 constant Canadian dollars) relative to brand use (C$7902 vs. C$6419/person-year; cost ratio (CR) = 1.22; p = 0.05), despite the lower cost of generic lamotrigine. Non-lamotrigine costs were 33% higher in the generic period (?p = 0.013). Both conversion methods yielded increases in total projected health care costs excluding lamotrigine (2006 constant US dollars) during the generic period (Method 1: cost difference: US$1758/person-year, CR = 1.33, p = 0.01); Method 2: cost difference: US$2516, CR = 1.39, p = 0.004).

Limitations: Study limitations pertain to treatment differences, indicators used for conversion and possible claim inaccuracies.

Conclusion: Use of generic lamotrigine in Canada was significantly associated with increased overall medical costs compared to brand use. Projected overall US health care costs would likely increase as well.     

Budgetary impact of treating acute bipolar mania in hospitalized patients with quetiapine: an economic analysis of clinical trials

ABSTRACT

Objective: To present a tool that allows estimation of the budget impact of treatments for acute mania in bipolar I disorder from a US healthcare payer perspective.

Methods: Using discrete event simulation, the course of individuals is simulated beginning with hospitalization. Discharge depends on symptom level measured by the Young Mania Rating Scale (YMRS). The treatment effect is determined using time-dependent regression equations derived from trial data, and decision rules obtained from clinical experts. Outcomes include: time to response and symptom resolution; proportion of subjects reaching each outcome; number of adverse events. Costs were obtained from hospital discharge databases, the National Medicare Physician Fee Schedule and RedBook. Different scenarios are examined, each describing the proportion of subjects on the various treatments (lithium, divalproex sodium, olanzapine, risperidone, and quetiapine – monotherapy and in combination with lithium). Analyses are intention-to-treat over 100 days, corresponding to follow-up in mania trials. Despite its flexibility and structural adaptability, the model has some important limitations related to the characteristics of the clinical trials. These include focus on inpatient management of acute mania, use of the YMRS as the model driver, polypharmacy restricted to two-drug regimens, no explicit consideration of titration and dose changes, and relatively short time horizon.

Results: Scenarios with a greater proportion of quetiapine users (5% vs. 40% and 100%) result in a smaller impact on the healthcare budget ($6912, $6277, and $5525 per patient, respectively) and improvements in patient outcomes (e.g., 43%, 47%, and 54% responding at day 21; 74%, 77%, and 80% remitting by day 84). Sensitivity analyses showed that the budget impact is influenced by drug prices, discharge criteria and side-effect management.

Conclusion: Results suggest that increased use of quetiapine for bipolar mania in the US is economically justified and improves health outcomes. In addition, this model illustrates that discrete event simulation is a useful and versatile tool for budget impact analyses.     

144例住院患者输血不良反应的调查分析

目的 探讨不同血液制品引发的输血不良反应发生率,并分析造成输血不良反应的相关因素。方法 回顾性分析本市各大医院2012年1月~2014年1月进行输血的6813例住院患者的临床资料。结果 6813例住院输血患者中,共有144例患者接受输血治疗后发生不良反应,不良反应率为2.11%。冰冻血浆、手工血小板以及冷沉淀输血的不良反应率分别为5.84%、3.22%、3.77%。患者的输血不良反应多发生在输血开始的1 h内,而既往有输血史或妊娠史的患者输血不良反应发生率较高（P〈0.05）。结论 临床输注血浆以及血小板需要密切监测患者的一般情况。此外,对于既往有输血史或妊娠史的患者,更需要医护人员的密切关注,在出现输血不良反应的早期及时进行干预。     

术中自体血液回收与回输的应用研究

目的 :探讨自体血液回收技术在血液保护中的作用。方法 :运用ZITI—2000型血液回收机回收与回输自体血116例。监测术前、术中HR、MAP、SPO2、HB、Hct、plt的变化 ;测定红细胞悬液的Hct;记录每例回收血量、回输血量和异体输血率。结果 :(1)平均每例回收血3379ml,回输血液1235ml,异体输血率为25.8 %。(2)回输后HR、MAP、SPO2、HB、Hct显著上升 (P<0.01) ,plt无显著变化。(3)回输红细胞悬液Hct为0.41～0.49。结论 :自体血液回收技术是一种安全、可靠的血液保护技术 ,可大大节约血源和减少异体输血     

血小板抗体检测及交叉配型在临床血小板输注中的应用

目的探讨血小板抗体检测及交叉配型对血小板输注疗效的影响。方法需输注血小板治疗的患者350例分为既往无输血史（A组,110例）和有输血史（B组,240例）两组,采用固相凝集法检测血小板抗体。其中,血小板抗体阳性99例,61例行给予配合性血小板输注（C组）,38例行随机血小板输注（D组）;计算输注后1 h和24 h血小板升高指数（CCI）,CCI＞4.5×109／L判为输注有效。结果 B组血小板抗体阳性率为37.50％,高于A组的8.18％（ P＜0．05 ）,且随着输血次数增多而增高。C组血小板输注有效率高于D组（83.61％ vs ．26.32％）（P＜0．05）。结论接受异体输血的患者易产生血小板抗体;对血小板抗体阳性患者实施交叉配型可明显提高血小板输注的有效性。