大剂量输血程序改进及在失血性休克患者中的应用

doi:10.3761/j.issn.0254-1769.2023.21.006

摘要/Abstract

摘要： 目的改进大剂量输血程序，以缩短临床创伤失血性休克患者的输血准备时间，改善患者结局。方法便利选取2021年1月—12月急诊创伤失血性休克患者作为研究对象，其中2021年7月—12月纳入的患者作为试验组，采用改进后的大剂量输血程序进行救治，2021年1月—6月纳入的患者作为对照组，采用常规输血程序进行救治。比较两组的时效性指标与结局指标。结果应用改进的大剂量输血程序后，血型血常规送检时间从15 min缩短至8 min（U=143.50，P=0.024），输血准备时间从31 min缩短至19 min（U=126.50，P=0.026），决策备血时间从44 min缩短至18 min（U=152.50，P=0.007），急诊停留时间从135 min缩短至114 min（U=91.50，P=0.036），患者的转归分布得到改善（χ²=10.64，P=0.031）。结论采用改进的大剂量输血程序能明显缩短创伤失血性休克患者的输血准备时间，提高患者救治成功率。

关键词: 输血, 创伤, 失血性休克, 急诊

Abstract:

Objective In order to improve the "high-dose blood transfusion procedure"，shorten the preparation time for blood transfusion in patients with clinical traumatic hemorrhagic shock，and improve the outcome of patients. Methods Patients with emergency traumatic hemorrhagic shock from January to December 2021 were selected as the study subjects. Patients who received improved high-dose transfusion procedures from July to December were selected as the experimental group，and patients who received conventional transfusion procedures from January to June were selected as the control group. The timeliness indexes and outcome indexes of the 2 groups were compared. Results The delivery time for blood type and routine examination was shortened from 15 min to 8 min（U=143.50，P=0.024）；transfusion preparation time was shortened from 31 min to 19 min（U=126.50，P=0.026）；the time for decision-making blood preparation was shortened from 44 min to 18 min（U=152.50，P=0.007）；emergency stay time was shortened from 135 min to 114 min（U=91.50，P=0.036）；the outcome distribution of patients（χ²=10.64，P=0.031） was improved. Conclusion The improved high-dose blood transfusion procedure can significantly shorten the blood transfusion preparation time for patients with traumatic hemorrhagic shock and improve the treatment rate of patients.

Key words: Transfusion, Wound, Traumatic Hemorrhagic Shock, Emergency

丁幼芽, 王钰炜, 闫丹萍, 王飒. 大剂量输血程序改进及在失血性休克患者中的应用[J]. 中华护理杂志, 2023, 58(21): 2604-2609.

DING Youya, WANG Yuwei, YAN Danping, WANG Sa. Improvement of high dose blood transfusion procedure and its application in the treatment of patients with traumatic hemorrhagic shock[J]. Chinese Journal of Nursing, 2023, 58(21): 2604-2609.

图/表 4

图1 改进后的大剂量输血程序注：“创伤血套餐”包括血常规、血型、凝血谱、血生化、心肌酶谱、传染病4项检测、血气分析。

Figure 1 Improved high-dose blood transfusion procedure

图2 原大剂量输血程序注：“创伤血套餐”包括血常规、血型、凝血谱、血生化、心肌酶谱、传染病4项检测、血气分析。

Figure 2 Traditional high-dose blood transfusion procedure

表1 创伤失血性休克患者的一般资料

Table 1 General information of patients with traumatic hemorrhagic shock

表2 创伤失血性休克患者输血相关时效性指标[min，M（P25，P75）]

Table 2 Timeliness indicators related to blood transfusion in patients with traumatic hemorrhagic shock[min，M（P25，P75）]

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