Smudla Anikó, Fülesdi Béla, Babik Barna, Gál János, Matusovits Andrea, Fazakas János
Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1083.
Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika,Debreceni Egyetem, Debrecen.
Orv Hetil. 2020 Sep;161(37):1606-1616. doi: 10.1556/650.2020.31937.
In the last decade, guidelines and trainings promoted haemostasis point-of-care tests, availability and application of factor products, while they led to a decrease in blood product consumption. The aim of this study is to examine protocols, conditions in terms of facilities, equipment, personnel of anaesthesia-intensive care units (A-ICU) to improve healthcare services and patient safety.
In 2019, self-reported questionnaires were sent in e-mail to A-ICUs. Application of guidelines and local protocols, education, haemostasis diagnostic tools, availability of allogeneic transfusion products, stable factor and drug products for restoring haemostasis were evaluated.
49% of A-ICUs filled out 46 questionnaires. 91.3% applied guidelines, 43.5% had local protocols. The lack of haemostasis and Patient Blood Management (PBM) trainings was indicated by 6 and 17 A-ICUs, respectively. Applying MAITT guidelines decreased red blood cell concentrate (RBC), fresh frozen plasma (FFP) and thrombocyte consumption by 65.1%, 67.4% and 30.2%. The availability of laboratory and viscoelastic tests is limited except for blood count, INR, APTI, fibrinogen. Where viscoelastic tests were available, RBC 2.9, FFP 1.7, thrombocyte 2.5 times more physicians per A-ICU beds participated in haemostasis trainings. 32% of A-ICUs can provide the required amount of factor products in the case of massive bleeding.
Haemostasis and PBM trainings improve the quality of healthcare services if necessary equipment, factor and haemostasis drug products are provided. In order to promote PBM programmes and to improve patient safety, rearrangement of service and financing structure is needed, which must be accompanied by consulting perioperative professionals, general practitioners, and other related experts. Orv Hetil. 2020; 161(37): 1606-1616.
在过去十年中，指南和培训推动了止血床旁检测、凝血因子产品的可及性与应用，同时导致了血液制品消耗量的减少。本研究的目的是检查麻醉重症监护病房（A-ICU）在设施、设备、人员方面的方案和条件，以改善医疗服务和患者安全。
2019年，通过电子邮件向A-ICU发送了自我报告问卷。评估了指南和当地方案的应用、教育、止血诊断工具、异体输血产品的可及性、用于恢复止血的稳定凝血因子和药品。
49%的A-ICU填写了46份问卷。91.3%应用了指南，43.5%有当地方案。分别有6个和17个A-ICU表示缺乏止血和患者血液管理（PBM）培训。应用MAITT指南使红细胞浓缩液（RBC）、新鲜冰冻血浆（FFP）和血小板消耗量分别降低了65.1%、67.4%和30.2%。除血细胞计数、国际标准化比值（INR）、活化部分凝血活酶时间（APTI）、纤维蛋白原外，实验室和粘弹性检测的可及性有限。在有粘弹性检测的地方，每个A-ICU床位参与止血培训的医生人数是RBC的2.9倍、FFP的1.7倍、血小板的2.5倍。32%的A-ICU在大出血情况下能够提供所需数量的凝血因子产品。
如果提供必要的设备、凝血因子和止血药品，止血和PBM培训可提高医疗服务质量。为了推广PBM项目并提高患者安全，需要重新安排服务和融资结构，这必须伴随着咨询围手术期专业人员、全科医生和其他相关专家。《匈牙利医学周报》。2020年；161(37): 1606 - 1616。
