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机构大规模输血协议遵守的绩效改进计划审查:改进的机会

Thomas Easterday¹, Saskya Byerly¹, Louis Magnotti¹

¹Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.

The American surgeon

|February 1, 2024

概括

遵守大量输血协议 (MTP) 血和血小板的比率显著降低创伤患者的住院死亡率. 确保正确的血液产品比率对于改善严重受伤个体的结果至关重要.

科学领域:

创伤外科手术是什么
关键护理医学关键护理医学
流血性休克管理的管理.

背景情况:

大规模输血协议 (MTP) 是资源密集型的,需要提高性能.
这项研究评估了MTP血:红细胞 (1:2) 和血小板:红细胞 (1:12) 的比例.

研究的目的:

测试这样的假设,即遵守MTP比率与较低的住院患者死亡率有关.
确定与MTP不遵守相关的因素及其对死亡率的影响.

主要方法:

对成人创伤患者的回顾性审查,在4小时内接受≥6单位的红血细胞.
排除标准包括医院间转移,医院前心脏骤停和严重头部损伤 (AIS ≥5).
使用单变量和逻辑回归分析来确定与不遵守和死亡率的关联.

主要成果:

分析了383名患者;住院患者死亡率为28.5%.
增加的年龄,伤害严重性得分 (ISS),INR和输血的全血制品与更高的死亡率相关.
坚持目标血和血小板比率是对死亡率的保护 (OR分别为0.451和0.402).

结论:

与MTP指南相比,严重受伤的患者中有很大一部分接受了低于最佳的血和血小板体积.
在4小时内未能达到目标比率,与住院患者死亡率的增加有很强的相关性.
对MTP过程和结果的定期评估对于协议的遵守和最佳的患者护理至关重要.

关键词:

伤害控制复苏复苏复苏.大规模输血协议.提高绩效,提高工作效率.协议的遵守协议的遵守输血比率输血比率输血比率

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