CAJ | 학술논문

目的评价多学科血液管理措施对心脏瓣膜手术患者输血和住院期间转归的影响.方法 2009年阜外心血管病医院实施血液管理前和实施3年后各1年内连续完成的心脏瓣膜手术患者3 951例.通过制定围手术期输血指征,预防应用合成抗纤溶药,降低体外循环对血液的稀释程度,应用血液回收机等血液保护措施,建立临床用血公示制度等,加强围手术期各环节合理用血的管理.记录围手术期输血(包括血液制品)种类和量、合成抗纤溶药及血液回收机使用,住院时间、术后肺炎和死亡等.结果血液管理前组1 713例,血液管理后组2 238例.血液管理后组患者围手术期红细胞输注率(血液管理前组75.3%,血液管理后组28.5%,P=0.000),平均红细胞用量(4.0 U与1.2 U,P=0.000)均降低.血液管理后组患者住院时间(10.5 d与8.2 d,P=0.02),术后肺部感染发生率(3.5%与2.7%,P=0.04)及住院期间死亡率(1.2%与0.6%,P=0.000)减少.结论多学科血液管理显著减少心脏瓣膜手术患者输血率和输血量,降低手术后肺炎发生率和死亡率,减少住院时间,同时节省大量稀缺的血液资源.
목적 평개다학과혈액관리조시대심장판막수술환자수혈화주원기간전귀적영향.방법 2009년부외심혈관병의원실시혈액관리전화실시3년후각1년내련속완성적심장판막수술환자3 951례.통과제정위수술기수혈지정,예방응용합성항섬용약,강저체외순배대혈액적희석정도,응용혈액회수궤등혈액보호조시,건립림상용혈공시제도등,가강위수술기각배절합리용혈적관리.기록위수술기수혈(포괄혈액제품)충류화량、합성항섬용약급혈액회수궤사용,주원시간、술후폐염화사망등.결과 혈액관리전조1 713례,혈액관리후조2 238례.혈액관리후조환자위수술기홍세포수주솔(혈액관리전조75.3%,혈액관리후조28.5%,P=0.000),평균홍세포용량(4.0 U여1.2 U,P=0.000)균강저.혈액관리후조환자주원시간(10.5 d여8.2 d,P=0.02),술후폐부감염발생솔(3.5%여2.7%,P=0.04)급주원기간사망솔(1.2%여0.6%,P=0.000)감소.결론 다학과혈액관리현저감소심장판막수술환자수혈솔화수혈량,강저수술후폐염발생솔화사망솔,감소주원시간,동시절성대량희결적혈액자원.
To evaluate the effect of multidisciplinary blood management strategy in adults patients undergoing valvular heart surgery. Methods A multidisciplinary patient blood management (PBM) strategy was instituted in Fuwai Hospital since January 2009. It includes Establishment of a multidisciplinary blood transfusion management team and designation of a coordinator; Enactment perioperative transfusion triggers (Hb<80 g/L) for adults patients undergoing cardiac surgery; recommendation of antifibrinolytics, cell salvage, reduced cardiopulmonary bypass circuit; setting up Blood Consumption Announcement and Scoring System, which regularly publishes notifications of blood volume consumed per case, per single procedure and per surgeon. Clinical date before and after multidisciplinary patient blood management strategy will be presented. Results A total of 3 951 consecutive patients underwent Valvular Heart Surgery were analyzed.1 713 cases were in pre-PBM group, and 2 238 cases were in post-PBM group. Both incidence and average units of allogeneic red blood cell transfusion perioperatively in post-PBM group were decreased (28.5% vs 75.3%, P=0.000, and 1.2 U vs 4.0 U, P=0.000). The postoperative length of stay in hospital and incidence of pneumonia were reduced in post-PBM group (8.2 d vs 10.5 d, P=0.02, and 2.7% vs 3.5%, P=0.04). The post-PBM group had lower in-hospital mortality (0.6% vs 1.2%, P=0.000). Conclusion Multidisciplinary patient blood management strategy significantly reduced blood transfusion, morbidity and mortality in patients underwent valvular heart surgery. It save plenty of blood resources.