血液管理

在OR和ICU的标准操作流程中，将封闭式血液取样（CBS）作为患者血液管理（PBM）流程的一部分可有助于达到积极的患者预后转归，同时可以提供具有成本效益的治疗。与传统血液取样操作相比，已证明CBS可以更有效保存血液、改善患者转归预后并降低成本。12,17,22,23,25

患者血液管理（PBM）
患者血液管理（PBM）及时应用了循证医学和手术概念，旨在通过维持血红蛋白浓度、优化止血并最大限度减少失血来改善患者转归预后。31

常规血液取样的临床和经济影响
常规血液取样操作可能会导致大量失血、不必要的血液浪费和感染风险。临床影响可能包括贫血、输血和医院获得性感染，可导致患者转归不佳不良预后。使用常规血液采集的方法也会使医院成本增加。1-4, 6-9, 11-16, 18, 20-21, 25, 30, 34
封闭式血液取样（CBS）

封闭式血液取样（CBS）是一种循证解决方案。12,22,23

在OR和ICU的标准操作流程中，将封闭式血液取样（CBS）作为患者血液管理（PBM）流程的一部分可有助于达到积极的患者转归预后，同时可以提供具有成本效益的治疗。32

封闭式血液取样（CBS）是一种循证解决方案。12,22,23

减少失血

总抽血量与弃血量的比较

废弃血液占重症患者每日采血总量的

18％至30％ 3

  • 在ICU，每天采血 5 - 24次1,2
  • 每天抽取的血量可能为 26 - 427 mL 2-6
  • ICU患者因静脉采血而导致的每周失血量可能为 340 - 660 mL18
  • 每次采血废弃的血液为 2 - 10 mL不等3,9

封闭式血液取样（CBS）是一种循证解决方案。12,22,23

减少医源性贫血

取样并废弃导致的失血会导致血红蛋白（Hb）下降，从而引起贫血。13,16-18

减少医源性贫血

贫血与沉重负担以及器官损伤和死亡的风险增加相关。2,26

减少采血引起的贫血可以减少输血需求。3 此外，通过建立血液管理文化，可以减少医源性贫血。3

  • 每采血50 mL，中重度医源性贫血的风险增加18％ 3
  • 住院时间（LOS）在21天以上的患者，采血量增加超过3.5 mL／天，需要输血以纠正贫血的风险增加2倍 3
  • 贫血会对患者的生活质量产生负面影响，并与心脏相关发病率和死亡率的风险增加相关 2,26

封闭式血液取样（CBS）是一种循证解决方案。12,22,23

减少导管相关血流感染（CRBSI）

CBS会形成封闭的输注管路，可减少管腔内污染引起的并发症。12

污染率比较

已证明CBS与三通旋塞阀系统相比可以减少管腔内液体污染（分别为7％和61％）。28一项随机对照试验发现，CBS（1.8％）的管腔内液体污染率低于三通旋塞阀系统（8.2％）。12

美国每年有50,000名患者发生CRBSI 27

  • 在危重病患者中，CRBSI占感染的19％27
  • 在儿科ICU，31％的院内感染都是CRBSI27

封闭式血液取样（CBS）是一种循证解决方案。12,22,23

减少输血需求和相关并发症

红细胞输血与很多不良反应相关。25

输血需求

在ICU，通过改善患者血液管理来减少取样造成的失血可能会减少输血需求并减少输血相关并发症，15,19,20,22,24 其中包括：
  • 输血相关急性肺损伤（TRALI）、输血相关循环超负荷（TACO）、急性呼吸窘迫综合征（ARDS）、感染和呼吸机相关性肺炎 25
  • 在各种人群中，红细胞输血与较高的术后感染率相关 2
  • 输血患者在ICU和医院的死亡率增加、感染率增加、器官衰竭、ICU住院时间延长24

封闭式血液取样可以通过减少输血发生率来帮助降低医院成本。25

降低住院成本

RBC单位成本为

522 - 118330美元

  • 与输血相关的短期和长期不良事件是医疗支出中成本最高的因素之一。33
  • 此外，CBS可以通过降低污染风险来帮助您减少因医院获得性并发症（HAC）而造成的处罚。34,35

通过将封闭式血液取样方法纳入患者血液管理项目，可以改善患者预后。32

Edwards 临床教育

促进临床进步的血流动力学教育

始终致力于通过教育来改善外科和重症监护患者的护理质量，无论您在学习过程中的哪个阶段，Edwards临床教育都能向您提供一系列的资源和工具，在您目前和未来面临临床挑战时，可以为您不断提供支持。

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参考文献：
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