通过实施患者血液管理计划改进心胸外科输血实践。

Q4 Medicine Journal of Chest Surgery Pub Date : 2024-04-08 DOI:10.5090/jcs.23.160
Hee-Jung Kim, H. Shin, Suk Woo Lee, S. Heo, Seung Hyong Lee, Ji Eon Kim, Ho-Sung Son, Jae-Seung Jung
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引用次数: 0

摘要

背景在这项研究中,我们探讨了患者血液管理(PBM)计划对心胸外科输注红细胞(RBC)实践的影响。方法PBM计划包括三个部分:通过医嘱沟通系统检查表监控输血情况、对医疗团队进行PBM教育以及向下达医嘱的医生提供输血适当性反馈。回顾性分析研究了在实施 PBM 之前、期间和之后,引发输血的血红蛋白水平和适当输注红细胞比例的变化。进一步分析的重点是接受心脏手术的患者,结果包括 30 天死亡率、重症监护室和住院时间,以及肺炎、败血症和伤口并发症的发生率。实施 PBM 后,输注红细胞的血红蛋白阈值显著下降。该阈值从 PBM 前的 8.7 g/dL 降至 PBM 教育阶段的 8.3 g/dL 和 PBM 反馈阶段的 8.0 g/dL。此外,适当输注红细胞的比例也明显增加,从 PBM 前的 23.9% 分别增加到教育阶段的 34.9% 和反馈阶段的 58.2%。在接受心脏手术的 381 名患者中,住院时间明显缩短(p<0.001)。结论 PBM 的实施有效降低了心胸外科输注红细胞的血红蛋白阈值,提高了适当输血的比例。虽然输血实践有所改善,但临床结果与实施 PBM 之前观察到的结果相当。
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Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program.
Background In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. Methods The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. Results The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. Conclusion PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.
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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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