目的 构建基于移动护理的输血闭环管理系统,并探索其应用价值.方法 由徐州医科大学附属医院护理部、输血科和信息处等多部门协同构建基于移动护理的输血闭环管理系统,并于2022 年3 月起将该系统应用于临床实践.分析该系统应用前(2021 年9 月～2022 年2 月)和应用后(2022 年3～8 月)的输血质量、输血执行规范情况、输血平均时间和医务人员满意度.结果 系统应用后,4 h内完成输血率和输血前 15 min巡视率均较应用前更高,输血异常率和输血器4h未更换率均较应用前更低(P均<0.05).系统应用后,血样采集查对合格率、床旁输血查对合格率和输血规范化记录率均较应用前更高(P均<0.05).系统应用后,医师、护士和输血科人员配合1 例患者的输血时间均较应用前缩短,各项满意度评分均较应用前更高(P均<0.05).结论 建立基于移动护理的输血闭环管理系统不仅能够提高输血质量和医务人员满意度,还能改善输血执行规范情况,缩短患者的输血时间.

Objective:To compare the image quality and Qanadli embolism index between deep learning image reconstruction (DLR) and adaptive statistical iterative reconstruction-veo (ASiR-V) in dual low-dose CT pulmonary angiography (CTPA) with low contrast agent dose and low radiation dose.Methods:Eighty-eight patients who underwent dual low-dose CTPA in the radiology department of the affiliated hospital of Xuzhou Medical University from October 2020 to March 2021 were retrospectively analyzed, including 44 males and 44 females, aged from 11 to 87 years (61±15 years). The CTPA examination were performed using 80 kV tube voltage and 20 ml contrast agent. The raw data were reconstructed using standard kernel DLR high level (DL-H) and ASiR-V reconstruction, respectively. The patients were divided into standard kernel DL-H group ( n=88, 33 cases of positive embolism) and ASiR-V group ( n=88, 36 cases of positive embolism). The CT value, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective image quality score, Qanadli embolism index, positive rate and positive Qanadli embolism index were compared between the two groups. Results:There were no statistically significant differences in CT values of the main pulmonary artery, the right pulmonary artery and the left pulmonary artery between the standard kernel DL-H group and ASiR-V group [(405.8±111.7) vs (404.0±112.0) HU, (412.9±113.1) vs (411.5±112.2) HU, (418.1±119.9) vs (415.4±118.0) HU, respectively;all P>0.05)]. The image noise of the main pulmonary artery, the right pulmonary artery and the left pulmonary artery in the standard kernel DL-H group was significantly lower than the ASiR-V group(16.6±4.7 vs 28.1±4.8, 18.3±6.1 vs 29.8±4.9, 17.6±5.6 vs 28.4±4.7, respectively;all P<0.001). The SNR and CNR of the main pulmonary artery, the right pulmonary artery and the left pulmonary artery in the standard kernel DL-H group were significantly higher than the ASiR-V group(SNR: 25.5±7.1 vs 14.5±3.9, 23.9±7.2 vs 13.9±3.4, 24.9±7.4 vs 14.8±4.1, CNR: 21.6±6.6 vs 12.3±3.9, 20.2±6.7 vs 11.8±3.4, 21.2±6.9 vs 12.6±4.1, respectively;all P<0.001). The subjective image quality score of the standard kernel DL-H group was significantly higher than the ASiR-V group (4.6 vs 3.8, P<0.001). There were no significant difference in the Qanadli embolism index, positive rate and positive Qanadli embolism index between the two groups (all P>0.05). Conclusion:Compared with ASiR-V reconstruction algorithms group, standard kernel DL-H reconstruction algorithms can significantly improve the image quality of dual low-dose CTPA.

目的:探讨分析造血干细胞移植(HSCT)患者血小板输注疗效的影响因素.方法:选取2017年1月～2018年5月徐州医科大学附属医院收治的HSCT患者74例,对患者资料进行回顾性分析,并使用Logistic回归分析法检验影响患者血小板输注疗效的风险因素.结果:74例HSCT患者输注总有效率为70.3％.多因素Logistic回归分析结果显示,感染、脾肿大是影响HSCT患者血小板输注疗效的独立危险因素(OR分别为1.130、1.112,P<0.05).结论:感染、脾肿大是影响HSCT患者血小板输注疗效的独立风险因素,因此临床上给予HSCT患者输注血小板应做到个体化、科学化,以提高HSCT患者的临床疗效.

输血工作中遇到的急诊用血情况,会因血液库存不足、血型鉴定困难、抗体筛选试验阳性以及RH(D)阴性等问题的存在,影响病人的及时血液输注.为有效解决这一难题,笔者基于实际工作中紧急用血的经验积累,总结出一套有效应对紧急输血的处理办法.

目的 探讨临床输血发生的不良反应,并针对发生的不良反应制定相对应的预防措施.方法 选取2014年4月～～2015年4月我院发生输血反应的患者120例进行回顾性分析,总结其输血的不良反应及预防措施.结果 120例输血反应患者中,悬浮红细胞反应数为63例(52.5％)、洗涤红细胞和冷沉淀反应数为0例、冰冻血浆反应数为40例(33.33％)、单采血小板反应数为17例(14.17％).其中发热反应58例(48.33％)、过敏反应54例(45％)、其他8例(6.67％);其中发热反应中患者输注悬浮红细胞53例(91.38％),输注冰冻血浆5例(8.62％);过敏反应中患者输注悬浮红细胞16例(29.63％)、患者输注冰冻血浆22例(40.74％)、输注单采血小板20例(37.04％);发生其他反应的患者8例(100％),均为输注悬浮红细胞.结论 增强医务工作者的输血观念、完善血液质量控制体系、增强献血人群的献血意识是临床安全输血的保证,同时,在输血前对患者的实际情况进行全面的了解,采取针对性的预防措施,对降低输血不良反应也有积极的作用.

Objective To retrospectively analyze the clinical acute transfusion reactions, so as to explore how to reduce the clinical acute transfusion reactions. Methods 50 cases with acute transfusion reactions among the patients underwent different blood com-ponents infusion in our hospital from April 2014 to April 2015 were selected. And a comprehensive analysis was conducted on the clinical acute transfusion reactions in these 50 patients. Results Of the 50 cases, 16 cases had mild allergy symptoms, 27 cases had mild fever, 1 case had hemolytic reaction, 5 cases had rash, 1 case had bleeding due to transfusing too much volume of blood. The proportion of fever patients was 54%, which was significantly higher than that of the patients with other transfusion reactions, with statistical significant difference, P<0.05. Conclusion Reasonable blood transfusion and ensuring the smooth flow of vein are important measures for controlling the injuries due to acute transfusion reactions in the current clinical treatment to the maximum extent possible.