在冠状动脉旁路手术中输血实践的变化. 输血医学学术奖集团颁发
L T Goodnough1, M F Johnston, P T Toy
1Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, OH 44106.
JAMA
|January 2, 1991
概括
冠状动脉旁路移植手术的输血在各医院之间存在很大差异. 不必要的红细胞,血和血小板输血导致了患者护理中的这种显著变化.
科学领域:
- 心血管外科心血管外科
- 输血医学 输血医学
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 冠状动脉旁路移植 (CABG) 手术是一种常见的手术.
- 血液产品输血经常用于CABG,但可能会带来风险.
- 输血实践的变化可能会影响患者的治疗结果和资源利用.
研究的目的:
- 评估选择性,首次冠状动脉旁路移植 (CABG) 程序的血液产品输血率的机构变异性.
- 确定导致输血实践观察到变化的因素.
- 为了评估血液成分在CABG手术中的适当性.
主要方法:
- 在18个机构对540名患者进行了首次选择性CABG的审计.
- 对同源红细胞,血和血小板输血率的分析.
- 对患者和外科实践变量进行统计控制,以隔离输血实践因素.
主要成果:
- 红细胞 (平均为2.9U/患者,范围为0.4-6.3U),血 (32%的患者,范围为0-97%) 和血小板 (22%的患者,范围为0-80%) 输血的机构显著变化.
- 输血实践因素显著解释了红细胞输血的变化.
- 预防性输血部分解释了血和血小板使用的机构差异.
结论:
- 在CABG手术中使用血液成分具有广泛的机构差异.
- 在常规CABG程序中不必要的输血有助于这种变化.
- 标准化输血协议可能会提高CABG手术的效率和患者护理.
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