Karki O B
Department of Surgery, Manipal College of Medical Sciences, Phulbari-11, Pokhara, Nepal.
Kathmandu Univ Med J (KUMJ). 2016 Jan-Mar;14(53):27-30.
Background In surgical patients transfusion of blood is often a life-saving measure. Preoperative over-ordering of blood is very common and leads to holding up of the blood bank reserve and wastage of resources. Objective The main objective of this study was to evaluate the practice of cross-match and utilization of blood for general surgeries in a teaching hospital of Nepal, to identify the surgical procedures where type and screen can be introduced and to formulate a maximum surgical blood-order schedule for those procedures where a complete cross-match appears mandatory. Method Three hundred and eighty-eight patients of different general surgical procedures over a period of one year were evaluated. Blood units cross matched and units transfused intra-operative and post-operatively were recorded. Blood utilization was evaluated using the following indices: cross-matched to transfused ratio, transfusion probability and transfusion index. The maximum surgical blood-order schedule was calculated using Mead's criterion. Result Of the 601 blood units arranged for 388 patients, only 108 units were transfused in 81 patients. The cumulative non-utilisation of cross-matched blood was 82%. Based on these data, the maximum surgical blood-order schedule was calculated for seven common surgical procedures where cross-matching was justified. Conclusion Unwarranted cross-matching of blood is done in most procedures, especially cholecystectomies, hernia operations, breast surgeries, skin grafting, thyroidectomies etc. where a group and screen is adequate. Implementation of the recommended maximum surgical blood-order schedule and introduction of type and screen for eligible surgical procedures is a safe, effective and economic solution.
背景 在外科手术患者中，输血常常是一种挽救生命的措施。术前过度预订血液的情况非常普遍，这会导致血库储备积压和资源浪费。目的 本研究的主要目的是评估尼泊尔一家教学医院普通外科手术中交叉配血和用血的情况，确定可以引入血型鉴定和筛查的手术程序，并为那些似乎必须进行完全交叉配血的程序制定最大手术用血订单计划。方法 对一年内接受不同普通外科手术的388例患者进行评估。记录交叉配血的血液单位数量以及术中及术后输注的单位数量。使用以下指标评估血液利用情况：交叉配血与输注比例、输血概率和输血指数。使用米德标准计算最大手术用血订单计划。结果 在为388例患者安排的601个血液单位中，只有81例患者输注了108个单位。交叉配血血液的累计未使用率为82%。基于这些数据，为七种需要进行交叉配血的常见外科手术计算了最大手术用血订单计划。结论 在大多数手术中，尤其是胆囊切除术、疝气手术、乳房手术、皮肤移植、甲状腺切除术等，进行了不必要的交叉配血，而血型鉴定和筛查就足够了。实施推荐的最大手术用血订单计划，并为符合条件的手术程序引入血型鉴定和筛查，是一种安全、有效且经济的解决方案。
