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在新生儿重症监护病房开发和实施限制性血小板输血门
Natasha Lalos1, Alexa Brumfiel2, Luke T Viehl2
1Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, MO, USA. nlalos@wustl.edu.
概括
一项新的指导方针显著减少了早产新生儿不必要的血小板输血,降低了非指示的输血,而不会增加诸如心室内出血等严重出血事件.
科学领域:
- 新生儿医学 新生儿医学
- 血液学 血液学 血液学
- 儿科重症监护 儿科重症监护
背景情况:
- 血小板缺血在早产婴儿中很常见.
- 自由的血小板输血门与较高的发病率和死亡率有关.
- 需要标准化管理,以防止过度输血.
研究的目的:
- 制定和实施一项指导方针,用于管理早产新生儿的血小板缺血症.
- 为了减少非适用的血小板输血的速度.
- 评估对严重腹腔内出血和肺出血的影响.
主要方法:
- 通过使用计划-做-研究-行动 (PDSA) 周期开发和实施了一项指导方针.
- 包括出生体重小于1000克的婴儿.
- 血小板输血被分类为指示或非指示.
- 作为平衡措施,追踪了严重的3级或4级心室内出血和肺部出血.
主要成果:
- 该研究包括101名指南之前的婴儿和96名指南后的婴儿.
- 平均每月非指示输血量显著下降,从13.0降至2.0 (p < 0.01).
- 重度IVH和肺出血的发病率在指南后保持稳定.
结论:
- 基于证据的,严格的血小板输血指南有效地减少了不必要的输血.
- 实施导致非指示的血小板输血显著减少.
- 该指南并没有增加这一脆弱人群中的重大出血事件.
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