QCC在儿童医院特需门诊输液服务流程改进中的应用

目的：探索品管圈活动（QCC）在儿童医院特需门诊输液服务流程改进中的效果与体会。方法：成立“品管圈”组织,通过主题选定、拟定活动计划、目标设定、现状分析,制定输液各环节精细化流程并实施。结果：输液服务流程改进后患儿家长对输液各环节的满意度明显提升,患儿输液等候时间明显缩短,护士综合能力明显提高。结论：将QCC模式用于输液服务流程的改进,可以改善护理服务品质,提升护理工作质量,提高护士工作效率,建立和谐的工作团队,提高患儿及家长的满意度。     

Negative Impact of Blood Transfusion on Recurrence and Prognosis of Hepatocellular Carcinoma After Hepatic Resection

Background  In perioperative management of hepatic resection for hepatocellular carcinoma, excessive blood loss and blood transfusion greatly influence postoperative complications and prognosis of the patients. We evaluated the influence of blood products use on postoperative recurrence and prognosis of patients with hepatocellular carcinoma. Methods  The subjects were 66 patients who underwent elective hepatic resection for hepatocellular carcinoma without concomitant microwave or radiofrequency ablation therapy nor other malignancies between January 2001 and June 2006. We retrospectively investigated the influence of the use of blood products including red cell concentration and fresh frozen plasma on recurrence of hepatocellular carcinoma and overall survival. Results  In multivariate analysis, the dose of blood products transfusion was a significant predictor of disease-free and overall survival. Both disease-free and overall survival rates of those who were given blood products were significantly worse than those who did not receive. On the other hand, in univariate analysis of disease-free and overall survival after hepatic resection and clinical variables, the amount of blood loss was not a significant predictor of recurrence or death. Conclusion  Transfusion of blood products is associated with increased recurrence rate and worse survival after elective hepatic resection for patients with hepatocellular carcinoma.     

To chelate or not to chelate in MDS: That is the question!

Myelodysplastic syndromes (MDS) are a heterogeneous group of hemopathies that exhibit physical manifestations with clinical consequences of bone marrow failure and inherent risk of progression to acute myeloid leukemia. Iron overload (IO) is common in MDS due to chronic transfusion support and disease-related alterations in iron metabolism. IO has been conclusively associated with inferior outcomes among MDS patients. Despite lack of randomized trials showing a survival impact of iron chelation therapy (ICT), ICT is recommended by experts and guidelines for select MDS patients with IO and is often used. The availability of effective oral ICT agents has reignited the controversy regarding ICT use in patients with MDS and IO. Here we summarize the studies evaluating the value of ICT in MDS and suggest a practical approach for use of these therapies. We also highlight controversies regarding use of ICT in MDS and discuss some ongoing efforts to answer these questions.     

护理干预对门急诊输液患者心理状况的影响

目的 探讨护理干预对门急诊输液患者心理状况的影响.方法 采用症状自评量表(SCL-90)对600例门急诊输液患者进行问卷调查,了解其存在的心理状态后,进行输液前、中、后的心理护理,于输液治疗的最后1 d再次用SCL-90进行问卷调查,采用χ2检验比较2次评定的结果 .结果 心理护理后本组患者的躯体化,人际关系,焦虑,抑郁,敌对,恐怖,其他项目的 阳性分布情况均较干预前.有显著改善.结论 掌握患者的心理状况,做好静脉输液患者的心理护理,可有效减轻患者不良心理反应,提高护理安全质量,有利于疾病的治疗与康复.     

自血回输对脊椎手术患者小肠微循环的影响

【目的】观察自体血液回收应用于脊椎外科手术时血液保护效果及对小肠微循环的影响。【方法】40例ASA Ⅰ～Ⅱ级择期在全麻下行脊椎手术患者随机均分为自体血回输组（Ⅰ组）和异体血输注组（Ⅱ组）。记录两组患者术中失血量、异体血输注量及全麻诱导插管前（T1）、诱导结束后30min（T2）、术毕（T3）、术后24h（T4）的肠脂肪酸结合蛋白（I-FABP）和D-乳酸表达。【结果】与Ⅰ组比较,Ⅱ组异体血输注量增多,Ⅱ组在T3、T4时点I-FABP与D-乳酸表达增高。【结论】自体血液回输可以有效减少脊椎手术异体血的输注,对小肠微循环灌注影响小。     

血小板成分输注的疗效观察

目的　探讨输注成分血小板的疗效。方法　以血小板恢复率及纠正的血小板增值为判定指标 ,观测了30例恶性血液病患者 12 7例次预防或治疗性输注成分血小板的疗效 ,并与临床实际效果相比较。结果　输后 1小时血小板恢复率 >2 8%者占 5 9 8% (76 / 12 7例 ) ,输后 2 4小时血小板恢复率 >2 0 %者为 0 (0 / 12 7例 )。纠正的血小板增值在输后 1小时 >10 0× 10 9/L者占 5 5 9% (71/ 12 7例 ) ,输后 2 4小时 >7 5× 10 9/L者为 0 (0 / 12 7例 )。输注血小板后临床实际有效率为 96 7% (2 9/ 30例 ) ,与对照组比较差异显著 (P <0 0 5 )。结论　成分血小板输注具积极的疗效 ,其疗效判定应有一个与临床实际相符的判定标准     

Association entre les virus du syndrome d’immunodéficience acquise et le virus de l’hépatite C chez les jeunes donneurs de sang à Kinshasa : analyse rétrospective de 10 années

Study objectives

The screening of anti-Human Immunodeficiency Virus antibodies is mandatory in every blood donor admitted to the Blood Bank of Kinshasa University Clinics since 1984. However, no compiled data are available to date. The objective of this study was to establish the trend, prevalence, viral co-infections, and determinants of Human Immunodeficiency anti-Virus serology in blood donors admitted between 2003–2006 and 2008–2013.

Adverse transfusion reactions in recipients transfused in out-of-hospital

Objectives

Transfusion in environments other than inpatient hospitalisation requires a specific management of the patient, particularly concerning adverse transfusion reactions. A three-year study was carried out in order to appreciate the nature of adverse transfusion reactions and their incidence in these patients.

Profil clinico-biologique et immunohématologique des patients atteints de β-thalassémie en Tunisie : à propos de 26 cas

Aim of the studyTo study the clinical and biological profile of β-thalassemic patients in our region, reflecting the quality of their care.Patients and methodsA retrospective study (2010–2011) on 26 β-thalassemic patients followed in the pediatrics service at CHU Farhat Hached Sousse, Tunisia. Epidemiological, clinical and biological data were collected from medical records and transfusion files of patients. The transfusion protocol adopted was to maintain a hemoglobin level > 10 g/dL by regular transfusions every 3–4 weeks. Iron chelation therapy, in order to maintain serum ferritin < 1500 ng/mL, was introduced when serum ferritin exceeded 800–1000 ng/mL.ResultsThe mean age of patients at diagnosis was 15 months. The clinical impact of anemia had resulted in failure to thrive in 54% of patients and facial dysmorphism in 23%. The average transfusion requirement was estimated at 311.02 mL/kg/year with 6 cases of hyperconsumption. The immunohaematological monitoring showed the appearance of anti-RBC alloimmunization in one patient and 4 cases of autoimmunization. Poor adherence of chelation therapy was 62% and causing 5 cases of cardiac complications, 4 cases of liver injury and 14 cases of endocrine complications.ConclusionImproving the therapeutic care of β-thalassemic children requires better monitoring of transfusion recovery and improved adherence to chelation therapy.