评估手术中使用血液作为改变血液制品储备申请模式的工具。

Evaluation of the use of blood in surgeries as a tool to change patterns for requesting blood product reserves.

机构信息

Hospital Universitario Cassiano Antonio Moraes, Vitoria, ES, BR.

Faculdade de Medicina, Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria, Vitoria, ES, BR.

出版信息

Clinics (Sao Paulo). 2019;74:e652. doi: 10.6061/clinics/2019/e652. Epub 2019 Apr 25.

DOI:10.6061/clinics/2019/e652

PMID:31038643

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6467177/

Abstract

OBJECTIVES

Thirty to sixty percent of prepared blood products are not transfused. Blood reserves for surgeries lead to many unused blood products, which increases hospital costs. The aim of this study is to identify the request and use profiles of blood products for elective surgeries in different surgical specialties, the influence of surgery time and demographic, clinical, and laboratory variables on the number of red blood cells (RBCs) used and to calculate the rate of transfused patients (RTP) and cross-matched and transfused (C/T) RBCs.

METHODS

Observational and prospective studies. Sociodemographic, clinical and quantitative data on the request and use of blood products were collected. The influence of the data on the use of RBCs was examined by binary logistic regression. Chi-square, one-way ANOVA and Kruskal-Wallis tests were utilized to compare the data among the specialties.

RESULTS

In total, 822 procedures were included. Most of the requested blood products were not used, even 24 hours postoperatively. Of the 2,483 RBC units, 314 were transfused, leaving 87.6% unused; however, cardiac, digestive tract, vascular, gynecologic, urologic and thoracic surgery procedures transfused 50%, 25%, 16.5%, 11%, 9.5% and 8.1% of requested RBCs, respectively. The factors that influenced the transfusions were age, time of surgery and cardiac surgeries. The RTP was >10% in 22 surgical types and <1% in 24 surgical types, and 88% of samples presented a C/T ratio >2.5.

CONCLUSION

The RTP and C/T ratios can guide RBC requests in the preoperative period. Knowing the standard of use of blood products and developing protocols enables the optimization of reserves, reduction of costs and improvement of care.

摘要

目的

准备好的血液制品中有 30% 至 60%未被输注。手术用血储备导致许多未使用的血液制品，增加了医院成本。本研究旨在确定不同外科专业择期手术用血制品的需求和使用情况，手术时间以及人口统计学、临床和实验室变量对红细胞（RBC）使用量的影响，并计算输血患者比例（RTP）和交叉配血及输血（C/T）的 RBC 比例。

方法

观察性和前瞻性研究。收集用血制品的请求和使用的人口统计学、临床和定量数据。通过二项逻辑回归检查数据对 RBC 使用的影响。采用卡方检验、单因素方差分析和 Kruskal-Wallis 检验比较各专业间的数据。

结果

共纳入 822 例手术。即使在术后 24 小时，大多数请求的血液制品也未被使用。在 2483 个 RBC 单位中，有 314 个被输注，未使用的比例为 87.6%；然而，心脏、消化道、血管、妇科、泌尿科和胸外科手术分别输注了请求 RBC 的 50%、25%、16.5%、11%、9.5%和 8.1%。影响输血的因素是年龄、手术时间和心脏手术。22 种手术类型的 RTP>10%，24 种手术类型的 RTP<1%，88%的样本的 C/T 比值>2.5。