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Effect of Comprehensive and Whole Process Blood Management on Allogeneic Transfusion in Orthopedic Surgical Patients
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摘要:
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。 Abstract: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. -
Key words:
- blood management /
- allogeneic transfusion /
- orthopedic surgery
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表 1 2013年至2014年骨科手术患者基本情况
年份 骨科手术患者
(例)高出血风险手术
患者(例)女性
[例(%)]平均年龄
(岁)高出血风险手术[例(%)] 脊柱矫形融合手术 长节段胸腰椎手术 人工关节置换手术 骨折内固定手术 2013 3320 2178 1134(34.16) 49.5 390(17.91) 621(28.51) 825(37.88) 342(15.70) 2014 3762 2322 1365(36.28) 48.7 416(17.92) 653(28.12) 892(38.42) 361(15.54) P值 0.06 0.72 0.99 0.77 0.71 0.88 
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表 2 2013年至2014年骨科手术患者异体输血情况
年份 异体总输血量
(ml)异体输血单位数
(U)异体输血费用
(元)输血费用占输血患者
医疗总费用比例(%)输血费用占医疗
总费用比例(%)平均住院日
(d)并发症发生率
(%)2013 121 600 2804 750 330 1.04 0.42 12.90 5.03 2014 106 950 2543 680 720 0.97 0.35 12.46 2.02
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[1] Dunne JR, Malone D, Tracy JK. Perioperative anemia:an independent risk factor for infection, mortality, and resource utilization in surgery[J].J Surg Res, 2002, 102237-102244. http://www.ncbi.nlm.nih.gov/pubmed/11796024 [2] 余卓丽, 马春会, 田兆嵩.输血的利与弊[J].中国输血杂志, 2009, 22:239-242. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsxzz200903029 [3] 任芙蓉, 王憬惺, 赵海燕.我国5城市合格献血者血液HIV及HCV残余风险研究[J].中国输血杂志, 2007, 20:469-475. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsxzz200706004 [4] 张卫.输血与围术期血液管理[J].实用医院临床杂志, 2014, 11:6-8. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=syyylczz201402003 [5] 中华医学会麻醉学分会.围术期输血的专家共识[J].临床麻醉学杂志, 2009, 25:189-191. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmzxzz200903001 [6] Beattie WS, Karkouti K, Wijeysundera DN, et al.Risk associated with preoperative anemia in noncardiac surgery:a single-center cohort study[J].Anesthesiology, 2009, 110:574-581. doi: 10.1097/ALN.0b013e31819878d3 [7] Murphy MF, Waters JH, Wood EM, et al. Transfusing blood safely and appropriately[J]. BMJ, 2013, 347:f4303. doi: 10.1136/bmj.f4303 [8] AuBuchon JP.Meeting transfusion safety expectations[J].Ann Intern Med, 2005, 143:537-538. doi: 10.7326/0003-4819-143-7-200510040-00012 [9] Kleinman S, Chan P, Robillard P.Risks associated with transfusion of cellular blood components in Canada[J]. Transfus Med Rev, 2003, 17:120-162. doi: 10.1053/tmrv.2003.50009 [10] Goodnough LT, Shander A.Patient blood management[J].Anesthesiology, 2012, 116:1367-1376. doi: 10.1097/ALN.0b013e318254d1a3 [11] Lemes MJ, Healg WL. Blood transfusion in orthopedic operations[J]. J Bone Joint Surg(Am), 1996, 78:1260. doi: 10.2106/00004623-199608000-00019 [12] 巍威, 寇伯龙, 剧荣森, 等.麻醉后预存自体血在人工关节置换术中的应用[J].中国修复重建外科杂志, 2006, 20:627-629. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgxfcjwkzz200606011 [13] Provan D. Better blood transfusion[J]. BMJ, 1999, 318:1435-1436. doi: 10.1136/bmj.318.7196.1435 [14] Ridgeway S, Tai C, Alton P. Pre-donated autologous blood transfusion in scoliosis surgery[J].J Bone Joint Surg Br, 2003, 85:1032-1036. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=c7518936813646300d1578965251fcc0 [15] 薛彩霞, 常世卿, 赵俊桃, 等.急性等容稀释式和回收式自身输血技术在脊柱侧弯矫形术中的联合应用[J].临床血液学杂志, 2013, 26:852-854. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcxyxzz-s201306014 [16] Liang J, Shen J, Chua S, et al.Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study[J].Eur Spine J, 2015, 24:270-275. doi: 10.1007/s00586-014-3282-2 [17] 刘家明, 彭慧明, 沈建雄, 等.脊柱手术中应用氨甲环酸的有效性和安全性荟萃分析[J].中华外科杂志, 2010, 34:937-942. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhwk201012014 [18] 林进, 范彧, 常晓, 等.一期双侧人工全膝关节置换术后放置与不放置引流的对比研究[J].中华医学杂志, 2009, 89:1480-1483. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyx200921011 [19] 郝绍文, 金群华, 杨晓春.全膝关节置换术后引流管的拔管时机对隐性失血的影响[J].宁夏医科大学学报, 2013, 35:881-883. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=nxyxyxb201308013 -
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