| Abstract: | 血液製品在臨床上應用廣泛，重大醫療手術及急性出血可能需要大量血液製品輸注， 美國衛生及公共服務部在2011年統計指出美國在醫院輸注紅血球血品超過1350萬次輸血，估計花費達100億美元。近年來捐血者有減少趨勢又面臨人口老化，用血需求逐漸提升，經過臺灣血液基金會統計2017年全血捐血量較2016年減少13,397袋全血血品，血液製品資源珍貴，病人用血管理(patient blood management, PBM )策略顯得相當重要，評估患者用血適當性，給予正確血液成份，提供有效輸血治療。 許多文獻指出以臨床資訊決策系統((clinical decision support system, CDSS)能提供醫師決策方向，降低不適當醫療處置，提升疾病診斷及病人預後，臺中榮總輸血醫學科在2011年導入輸血相關資訊決策系統(Computerized Transfusion Decision Support System- Taichung Veterans General Hospital, CTDSS-VGHTC)來輔助醫師開立輸血醫囑，雖然國內許多醫院已逐步導入輸血相關資訊決策系統，但在輸注血品後效果及花費較無深入探討，導入因此利用臺中榮總臨床資料庫回溯性分析內科無出血風險患者導入輸血資訊決策系統(CTDSS-VGHTC)前後，觸發輸血(Transfusion trigger)時機點、血液製品輸注效果、住院天數及花費等分析。 導入輸血資訊決策系統(CTDSS-VGHTC)後輸注紅血球、新鮮冷凍血漿、血小板觸發輸注閾值上具有顯著改善，三種血液製品輸注量具有顯著降低，在血液血漿費用部分:紅血球費用具有顯著降低費用，新鮮冷凍血漿、血小板費用無差異；住院天數部分紅血球及新鮮冷凍血漿具有顯著降低，血小板則無差異，在輸注效果方面三種血液製品都具有顯著增加輸注效果。經過本研究顯示利用臺中榮總輸血相關資訊決策系統(CTDSS-VGHTC)能有效顯著降低輸注血液製品數量及提升輸血效果，建立有效輸血策略與病人用血管理，提升用血品質。
Blood products are widely used in the clinical practices. Major medical procedures and acute bleeding may require a large amount of blood product infusion. In recent years, the number of blood donors has a decreased trend. On the other hand, blood demand has gradually increased because of population aging. According to the statistics from Taiwan Blood Foundation, the total volume of blood donation decreased by 13,397 bags from 2016 to 2017. With such, the patient blood management (PBM) strategy becomes critical today, because PBM helps evaluate the appropriateness of blood for patients, give correct blood components, and provide effective blood transfusion therapy. Literature indicates that the clinical decision support system (CDSS) can provide physicians with decision-making directions, reduce inappropriate medical treatment, and improve disease diagnosis and patient prognosis. In 2011, Taichung Veterans General Hospital-Transfusion Medicine introduced the Computerized Transfusion Decision Support System-Taichung Veterans General Hospital (CTDSS-VGHTC) to assist physicians in making decisions of patient blood transfusions. Although many hospitals in Taiwan have gradually introduced CTDSS, the effects and costs of blood products infusion have not been investigated in depth. Hence, this research introduces a retrospective analysis of the patients for blood transfusion with no bleeding risk in the Department of Internal Medicine with CTDSS-VGHTC. The transfusion triggering timing, blood product infusion effect, lengths of hospital stay and costs are analyzed and compared between without and with CTDSS-VGHTC. The results showed infusion of red blood cells, fresh frozen plasma, and platelet-induced infusion thresholds were significantly reduced when using CTDSS-VGHTC. Additionally, there were significant reductions in the average infusion volume of the three blood products when using CTDSS-VGHTC. However, infusion of red blood cells is the only significant item in average cost reduction. This study shows CTDSS-VGHTC can effectively reduce the number of blood products infusion and improve blood transfusion effects. |
