Release date: 2014-06-17
The blood transfusion rate of cardiovascular surgery ranks first among all types of surgery. Due to the shortage of blood resources, the search for throttling measures has become an international problem. In 2009, Fuwai Hospital found a cracking technique. In the past five years, through technical innovation and management supervision, the blood transfusion rate of adult cardiovascular surgery has been reduced by 60%, which not only saves medical resources, but also eliminates the possibility of inputting allogeneic blood for patients. risk.
In order to achieve reasonable blood use, the Chinese Academy of Medical Sciences Fuwai Cardiovascular Hospital established the "No Transfusion Heart Surgery Center" on the 14th. This is a pioneering initiative for hospitals to improve the quality of care.
Increased volume of surgery and decreased blood transfusion rate
At present, the average blood transfusion rate of adult heart surgery in China is about 70%, and the blood transfusion rate of heart surgery in some hospitals reaches 100%. Even in the United States, where medical technology is developed, the average blood transfusion rate in adult cardiac surgery is around 45%-50%.
However, blood transfusion (transfusion of allogeneic blood) is equivalent to a single allogeneic cell transplantation. In addition to increasing the risk of blood-borne diseases and blood transfusion-related adverse reactions, allogeneic blood transfusion also increases the incidence of infection, complications and mortality in patients undergoing cardiac surgery, reducing long-term Survival rate.
As the leading medical institution for the treatment of cardiovascular diseases, the number of hospital visits has increased in the past five years, and the volume of cardiovascular surgery has increased by 58.1%. In contrast, the blood transfusion rate of adult cardiovascular surgery decreased from 70.5% to 26.7%.
In other words, more than 70% of patients who have undergone cardiac surgery at Fuwai Hospital do not need to lose allogeneic blood during hospitalization. In 2013, nearly 6,000 patients underwent “no blood†surgery in more than 8,000 adult surgical procedures.
At the same time, the blood transfusion rate of infants and young children has also decreased significantly. 800 cases of "bloodless" surgery for heart surgery in infants under 15 kg have been achieved.
“No blood transfusion†is supported by technological innovation
To achieve blood-saving, innovation in clinical medical technology is crucial.
In recent years, the hospital has carried out research and development on a series of new technologies for the treatment of critical cardiovascular diseases, complex congenital heart disease and pulmonary atresia in neonates. On the one hand, these new technologies can reduce surgical trauma, control bleeding during surgery or avoid unnecessary bleeding, and on the other hand can effectively reduce postoperative complications and improve medical quality.
In addition, improvements in extracorporeal circulation equipment and reinfusion technology have resulted in better blood-saving effects. The mini-newborn and infant-type tubing, the whole-course blood recovery device, and the continuous arteriovenous blood gas detector independently designed and developed by the hospital have been used in the surgery of adults and children, which has greatly reduced the blood transfusion rate and blood transfusion volume.
The key to the realization of clinical innovation is that the hospital has a solid research and technology incubation base. The three major centers in the cardiovascular field - the National Cardiovascular Center, the State Key Laboratory of Cardiovascular Diseases, and the National Cardiovascular Disease Clinical Medical Research Center have successively settled in Fuwai Hospital, from the simple cardiovascular disease medical center to the national cardiovascular system. The transformation of the Center for Disease Research has laid a solid foundation.
Standardize clinical blood to become the "top leader" project
"Heart surgery 'no blood' surgery does not have technical barriers, the key is the concept." Li Huijun, deputy director said that surgeons should reverse the concept of surgery relying on blood transfusion, establish a blood-saving awareness, reduce the patient's skills by improving the technical level In the middle of bleeding, to achieve no bleeding.
Fuwai Hospital has upgraded the standard clinical blood to the “first-hand†project, and has formulated the “Operational Procedures for Saving Bloodâ€, including the development of perioperative blood transfusion indications for cardiac surgery, improving the use rate of blood recovery machines, and preventing the application of antifibrinolytic drugs. Timely diagnosis of coagulation disorders, regular publicization of the disease room and the comparison of blood transfusion volume (rate) between single-species doctors, standardize systematic scientific and rational use of blood (including blood products), reduce intraoperative blood loss and unnecessary blood transfusion To improve the subjective initiative of the surgeon, and to achieve the goal of "no transfusion heart surgery" on the premise of ensuring patient safety.
In the entire process of blood-saving, the use of multi-disciplinary blood management "team operations." The medical department, blood transfusion department, surgery, anesthesiology department, extracorporeal circulation department, postoperative recovery room, cardiology department and other related departments are responsible and cooperate with each other. Surgeons strengthen hemostasis technology and responsibility, do their utmost to reduce intraoperative and postoperative blood loss, anesthesiologists should strengthen perioperative blood protection, extracorporeal circulation physicians should take blood protection measures, postoperative ICU physicians assume blood protection duties, medical services And the Department of Blood Transfusion is responsible for the management of clinical science, rational use of blood and blood transfusion data, and jointly form a multidisciplinary blood management pattern.
Source: People's Network
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