Blood Transfusion Practices in Military Medicine

Background

This observational study was conducted in a small, 45 bed border static hospital, located in a field area, where no blood bank facilities were available. The present study was conducted to elucidate the blood transfusion practices of this hospital. Methods: A retrospective analysis of all blood transfusions performed in this hospital between Dec 2004 and Dec 2006 was carried out. The data collection included blood group patterns, common indications, haemoglobin levels and complications of blood transfusion. Inferences were based on available data and relevant statistical analysis.

Result

A total of 246 blood transfusions were administered to 79 recipients during the study period. Only one patient had an Rh negative blood group. The most frequently transfused blood group was A Rh positive. Majority of transfusions were administered to surgical cases and the commonest indication was gunshot wounds with haemorrhagic shock. The mean haemoglobin at admission was 8.93 g/dl. The mean number of blood transfusions per patient was 3.13. No haemolytic or other transfusion reactions occurred in any of the transfusions.

Conclusion

This study demonstrates that blood transfusions can be safely administered in field conditions despite constraints of not having a blood bank.Key Words: Blood transfusion practices, Haemoglobin, Anaemia     

连续性血液净化治疗危重病合并高钾血症的临床探讨

目的 探讨连续性血液净化(CRRT)治疗危重病合并高钾血症的方法及效果,为临床治疗提供参考。方法 本院2010年4月至2011年4月收治入院的110例危重病合并高钾血症患者随机分成两组,对照组55例,行内科综合治疗;实验组55例,在内科综合治疗的基础上行连续性血液净化治疗。随访10～40 d,比较两组患者的血钾下降情况...     

脑血栓形成患者住院240例糖代谢异常分析

目的探讨脑血栓形成患者糖代谢异常情况,以帮助医师制定更合理的诊断和治疗方案。方法选取2008年3月至2009年3月在我院神经内科住院的急性脑血栓形成患者240例,记录患者空腹血糖、随机血糖,对未确诊糖尿病的患者进行75 g葡萄糖耐量试验(OGTT),以判断糖代谢情况。结果住院240例急性脑血栓形成患者中糖代谢异常136例(56.7%),其中糖尿病80例(33.3%),糖调节受损56例(23.4%);正常糖耐量104例(43.3%)。若不进行OGTT试验仅依靠空腹血糖判断,则有73.2%(41/56)糖调节受损和12.5%(10/80)糖尿病患者被漏诊。结论住院240例急性脑血栓形成患者大多数合并糖代谢异常,通过OGTT可以及时准确地发现患者合并糖代谢异常,有利于制订更合理的治疗方案。     

剖宫产术后切口感染的术中和术后相关因素分析

目的 探讨剖宫产切口感染术中、术后高危因素,为切口感染寻找最佳的预防措施和方法。方法 采用回顾性调查方法,调查可能与切口感染相关的术中及术后高危因素,包括是否急诊、麻醉方式、手术时间、手术医师的操作、住院天数、术中和失血量、术后护理等7项指标,并根据随机原则,取同一医院未感染的产妇进行对照。结果 在术中及术后的相关因素中,麻醉方式、住院天数、手术时间等3项指标在感染组和对照组有显著性差异(P<0.01)。失血量及急诊等2项指标经统计学分析,感染组和对照组无显著性差异(P>0.05)。结论 针对影响剖宫产切口感染的术中和术后高危因素,应制定有效的预防措施,以减少术后感染的发生。     

剖宫产术后切口感染的术中和术后相关因素分析

目的探讨剖宫产切口感染术中、术后高危因素，为切口感染寻找最佳的预防措施和方法。方法采用回顾性调查方法，调查可能与切口感染相关的术中及术后高危因素，包括是否急诊、麻醉方式、手术时间、手术医师的操作、住院天数、术中和失血量、术后护理等7项指标，并根据随机原则，取同一医院未感染的产妇进行对照。结果在术中及术后的相关因素中，麻醉方式、住院天数、手术时间等3项指标在感染组和对照组有显著性差异（P〈0．01）。失血量及急诊等2项指标经统计学分析，感染组和对照组无显著性差异（P〉0．05）。结论针对影响剖宫产切口感染的术中和术后高危因素．应制定有效的预防措施。以减少术后感染的发生。     

2009年～2011年陕西省临床血型鉴定室间质量评价分析

目的:探讨临床血型鉴定室间质量评价错误的原因。方法:分别统计2009年、2010年和2011年陕西省临床检验中心临床血型室间质量评价活动结果。结果:2009年全省正鉴定参评单位133家,ABO正鉴定错误单位为1家,占参评单位的0.75%,Rh血型鉴定错误单位为1家,占参评单位的0.75%,血型反鉴定参评单位126家,反鉴定错误单位为8家,占参评单位的6.35%;2010年全省正鉴定参评单位192家,ABO正鉴定错误单位为1家,占参评单位的0.52%,Rh血型鉴定错误单位为1家,占参评单位的0.52%,血型反鉴定参评单位190家,反鉴定错误单位为7家,占参评单位的3.68%;2011年全省正鉴定参评单位200家,ABO正鉴定错误单位为1家,占参评单位的0.5%;Rh血型鉴定错误单位为1家,占参评单位的0.5%,反鉴定参评单位195家,反鉴定错误单位为14家,占参评单位的7.18%。ABO血型鉴定错误主要表现在反向反应。结论:ABO试剂红细胞质量是引起血型错误主要原因。     

Evaluation of a home kit blood glucose monitoring device

A blood glucose monitoring device, the Diascan, is commonly used in Trinidad and Tobago. A prospective study was conducted to examine the accuracy of a Diascan unit in measuring blood glucose levels in or capillary venous blood of patients in a hospital ward. The Diascan measurements were compared to those from two laboratories which independently measured the venous blood or the venous plasma glucose levels. Although there was reasonably good correlation between measurements from the two laboratories (r = 0.85) results from the Diascan showed poor correlations with those from the laboratories, with Pearson's correlation coefficients ranging from 0.32 to 0.64. An error grid analysis showed that the Diascan measurements would have resulted in inappropriate decisions relating to treatment regimens in 26% of cases. The results suggest that, when crucial decisions have to be made with respect to patients' blood glucose levels, it may be risky to rely solely on measurements from the Diascan.     

输血病案质量与医疗安全

目的为医院的病案质量管理和医疗安全提供参考。方法制定输血病案专项检查标准,对320份输血病案进行质量分析。结果病案合格率：病案首页90.93%、输血同意书91.87%、输血前化验结果83.75%、输血指征92.18%、成份输血比例91.25%、输血观察记录77.50%。结论输血病案质量直接影响病案内涵和医疗质量与安全,医院应当加强输血病案质量管理,确保医疗安全,避免医疗纠纷。     

Detection of hypertension. Blood pressure determination in outpatient clinics of medical school-affiliated training programs.

We evaluated past medical records and conducted a hypertension screening program in the outpatient clinic of a university hospital, a community hospital, and a city hospital, with the aid of specially trained high school students under the direction of a cardiovascular nurse. Fifty-one percent of the adult black outpatients had elevations of arterial blood pressure; one half of these patients were aware of a history of hypertension. Analysis of the clinic records showed that many patients who had made multiple visits to the clinic had never had a blood pressure recorded in their charts. If progress is to be made in the detection of hypertension, blood pressures must be routinely determined. This should be incorporated into all clinic routines, particularly in clinics staffed by physicians-in-training.     

代谢综合征病人对出院健康小处方依从性分析及护理干预

目的：了解代谢综合征病人出院后饮食控制、增强运动等方面的依从性，评估护理干预措施对延缓MS心脑血管疾病病程的影响。方法：采用自行设计评价标准，出院后每个月电话随访，三个月后监测指标并进行问卷调查，分析76例MS病人健康小处方的依从相关问题，根据依从性差的原因进一步制定强化干预措施。结果i26例病人依从性好（占34％），55例病人依从性差（占66％）。其中9例病人出院后未改变任何生活方式。76例病人出院三个月后监测指标结果显示评分〉12分者体重、血压、血糖、血脂控制满意度明显好于评分〈12分者。（P分别为0．022、0．0410、0430、0．039）。结论：MS病人健康小处方的依从性与自身对疾病的认识、心理状态、临床症状的轻重、家族社会的支持以及医务人员的健康宣教和出院随访有关。有效的护理干预措施对提高健康宣教依从性具有积极影响。     

后腹膜腔镜根治性肾癌切除术与开放手术的疗效比较

目的 比较后腹膜腔镜根治性肾癌切除术与开放根治性肾癌切除手术的临床疗效.方法 回顾性分析90例经术后病理确诊的T1-2N0M0肾癌患者分别行后腹膜腔镜根治性肾切除术（后腹膜腔镜组）32例与开放根治性肾癌切除术（开放手术组）58例的临床资料,对比分析两种手术方法在手术时间、术中出血量、术后禁食时间、术后引流管留置时间、术后住院时间、并发症等方面的差异.结果 两组手术均获成功,后腹腔镜组平均手术时间为（86±17） min,术中出血量为（80±28） ml,术后禁食时间（28±7） h,术后引流管留置时间（2.8±1.4） d,术后住院时间（7.3±3.6） d,30例随访3-18个月,无复发及远处转移,死于脑血管疾病1例;开放手术组平均手术时间为（76±32） min,术中出血量为（140±57） ml,术后禁食时间（39±11） h,术后引流管留置时间（3.7±1.1） d,术后住院时间（9.3±2.8） d,51例随访3-24个月,无复发及远处转移,死于心、脑血管疾病3例.结论 与开放根治性肾癌切除术相比,后腹腔镜肾癌根治术具有出血少、住院时间短、恢复快等优点.     

Occupational exposure to blood and body fluids amongst health care workers in a teaching hospital of the armed forces

Background: Health care workers (HCWs) are at risk of infection with blood-borne viruses in the course of their work. Over 90% of these infections are occurring in low-income countries and most are preventable. However, the situation in the Armed Forces hospitals has always been thought to be much better than the public health facilities in India. The focus of the study was on assessing the exposure frequency amongst HCWs in a teaching hospital in the Armed Forces.Methods: A cross-sectional survey amongst HCWs involved in collecting blood samples and administering injections in all wards of the hospital was conducted. Selection of study participants was by simple random sampling. A pre-tested questionnaire was administered by unlinked, anonymous method.Result: Total sample studied was 70. The proportion of HCWs experiencing exposure to blood body fluid splash (BBF) and needlestick injury (NSI) during last one week was 47.1% and 31.43%, respectively. The incidence density of BBF exposure was 537.14 per 100 person years and that of NSI episodes was 228.57 per 100 person years. The reasons for not using personal protective equipment (PPE) ranged from busy schedule (37.14%, non use of PPE by co-workers (67.14%, emergencies (91.43%) risk that patients may get offended by PPE use by HCWs (27.14% to discomfort while using PPE (24.29%). All components of PPE were available as per only 34.29 percent.Conclusion: The high level of occupational exposure to blood and body fluids and consequent risk of infection amongst a group of HCWs in the Armed Forces highlights the urgent need for interventions to enhance the occupational safety of workers.     

腹直肌外缘切口治疗原发性输尿管癌30例

目的探讨输尿管癌的手术入路及手术范围，减少病人创伤，使病人早日康复。方法选择经腹直肌外缘切口，首先探查输尿管，以确定手术方法。结果本组30例病人行肾输尿管及膀胱袖状切除23例，肿瘤单纯切除行吻合术6例，除1例肿物与髂血管浸润不能切除外，均痊愈出院。结论腹直肌外缘切口避免了传统术式变换体位，时间长、创伤大、易感染、恢复慢的缺点，是治疗输尿管癌的理想术式。     

医院职工高血压现状的调查及防治

目的为了解医疗卫生人员原发性高血压的治疗现状及影响因素。方法2001年,对1687名职工进行第1次体检,分为在职医护组、在职非医护组、离退休组3组,统计高血压患病率、知晓率、治疗率、控制率、降压药物使用情况及高血压并发症。对全院职工进行多次高血压相关教育。2年后(2003年),对第1次入选对象进行第2次体检及统计。结果2001年职工高血压患病率为23.8%,其知晓率、治疗率及控制率分别为84.0%、80.8%、36.9%。经过2年的教育和治疗,2003年,患病率为25.2%,知晓率、治疗率及控制率升高为99.3%(新发生高血压的知晓率为87.5%)、89.4%和61.2%,与2年前比较差异有统计学意义(P<0.05,P<0.01)。医务人员高血压患病率与普通人群相比差异无统计学意义,但其知晓率、治疗率及控制率比普通人群高,差异有统计学意义(P<0.01)。在医务人员中,离退休人员的知晓率与控制率最高。结论经过高血压专题教育,高血压知晓率、治疗率及控制率均能显著提高。     

Enterococcal bacteraemia in a tertiary care hospital of North India

A prospective study was conducted to determine clinical and bacteriologic features and antibiotic resistance pattern of enterococci isolated from cases of bacteraemia over a 7-month period. A total of 103 patients were identified during the study period whose blood culture was found to be positive for Enterococcus species. Bacteraemia was nosocomially acquired in 100 patients and community acquired in three. Enterococcus faecalis was isolated in 99 patients and E faecium in four. Bacteraemia was polymicrobial in 34 patients. Majority of patients had serious underlying diseases and were on prior therapy with cephalosporins. A source of bacteraemia was found in 59 patients (57.2%); intravascular catheters being the most common identifiable source. Overall mortality rate was 5.8%. High level aminoglycoside resistance was found in 76 (73.8%) of the enterococcal isolates. Vancomycin resistance was not found in any of the isolates. Bacteraemia due to enterococci is emerging as a significant clinical problem in hospital settings. A watchful vigilance is therefore required as regards their antibiotic resistance pattern particularly high level aminoglycoside resistance and vancomycin resistance. In addition hospital practices like prolonged use of in situ catheters and inadvertent antibiotic usage need to be minimised.     

Seroprevalence of dengue infection in pregnant women and placental antibody transfer

BackgroundPregnant women and infants are vulnerable for developing severe dengue. This study was conducted to determine the seroprevalence of dengue infections among pregnant women, their offsprings and its association with outcomes.MethodsA cross-sectional study was conducted among pregnant women, admitted for delivery in a tertiary mother and child hospital in Thiruvananthapuram. Blood specimens (2 ml) were collected from the women during hospitalization in the first stage along with blood samples being drawn for other investigations. Umbilical cord blood was collected from the neonates. The samples were tested using IgG enzyme-linked immunosorbent assay (ELISA). Quantitative titres were also obtained, and index ratios were calculated using optical density values.ResultsSeroprevalence of dengue in antenatal women was 6.9% (95% confidence interval [CI]: 3.4–12.48). Among cord blood samples, the seropositivity was 10.8% (95% CI: 6.3–16.6). A significant correlation (Spearman rho: 0.653 and p value <0.001) was obtained between maternal and cord sample IgG index ratios. Agreement between maternal and cord blood IgG values was obtained using kappa as 0.742. The mean weight of newborns born to IgG-positive mothers was significantly lower than babies of IgG-negative mothers (2.3 vs 2.8; t = 2.64; p = 0.01). The mean gestational age at delivery was also significantly lower in IgG-positive mothers (36.29 vs 38.04 weeks; t = 2.48; p = 0.01).ConclusionSeroprevalence of dengue in antenatal women and in their offsprings is lower than other areas endemic for dengue. Dengue infection (any time before pregnancy) may result in preterm delivery and low birth weights.     

Red cell autoantibodies among thalassaemia patients in Hospital Universiti Sains Malaysia

INTRODUCTION: Thalassaemia is one of the major public health problems in Malaysia. Regular monthly blood transfusion remains the main treatment for severe thalassaemia patients. One of the complications of blood transfusion is the formation by the recipients of alloantibodies and autoantibodies against red blood cell (RBC) antigen. The purpose of this study was to determine the prevalence of RBC autoantibodies among multiple-transfused thalassaemic patients in our institution and factors that contribute to its development. METHODS: A prospective study was conducted in Haematology Laboratory, Hospital Universiti Sains Malaysia between January 2004 and December 2004. A total of 63 thalassaemia patients, who received regular blood transfusion were included in this study. Clinical and serological data were collected and analysed prospectively. Blood samples were subjected to standard blood bank procedures for screening of antibodies and their subsequent identification using reagent of Diamed-ID Gel microtyping system. RESULTS: There were 49 (77.8 percent) patients with Hb E/beta-thalassaemia, ten (15.9 percent) beta-thalassaemia major, three (4.7 percent) Hb H Constant Spring and one (1.6 percent) Hb H disease. Only one (1.6 percent) patient had autoantibodies. There were no statistical associations found between the formation of autoantibodies with age at the start of transfusion, number of packed cell transfused and splenectomy. CONCLUSION: Our data showed a low autoimmunisation rate in multiple-transfused thalassaemia patients in our hospital.     

Prospective measurement of glomerular filtration rate and effective renal plasma flow during treatment of malignant essential hypertension.

A longitudinal study of sequential measurement of glomerular filtration rate and effective renal plasma flow was conducted over a 5-year period of antihypertensive drug treatment, in four adult patients admitted to hospital with previously untreated malignant essential hypertension. Treatment produced a substantial and sustained lowering of systemic arterial blood pressure, compared with grossly elevated pretreatment levels. Nevertheless, glomerular filtration rate and effective renal plasma flow remained relatively stable in all four patients, at roughly the same level at which they were admitted. It was concluded that effective therapy for hypertension may not necessarily reverse the vascular changes of arteriolar fibrinoid necrosis, which characterize malignant essential hypertension. Permanent damage to the renal arterioles, and the territory of kidney supplied by these vessels, may be a feature of this condition.     

微创手术治疗颃脑损伤临床效果分析

目的:探讨微创手术治疗颅脑损伤临床效果。方法:选取2019年2月-2020年2月我院收治的颅脑损伤患者92例,应用随机数字表法将其分为2组,对照组应用开颅手术治疗,观察组应用微创手术治疗。比对患者治疗效果、术中出血量和住院时间。结果:观察组疗效高于对照组(P<0.05);观察组出血量低于对照组(P<0.05),观察组住院时间短于对照组(P<0.05)。结论:使用微创手术治疗颅脑损伤疗效确切,创伤较小,出血量低,住院时间短,有利于患者术后康复,值得临床上大力推广应用。     

2型糖尿病长期治疗后合并冠心病及脑梗死的多因素分析

目的 研究2型糖尿病长期治疗后合并冠状动脉粥样硬化性心脏病(简称冠心病)、脑梗死病变的患病率及相关危险因素.方法 收集广西医科大学第二附属医院前后两次住院时间间隔4～12年的2型糖尿病患者185例.第一次住院185例为A组,前后两次住院时间间隔5年左右(4～7年)的85例为B组,前后两次住院时间间隔10年左右(8～12年)的100例为C组.收集所有研究对象前后两次住院的临床资料,包括血压、血糖、糖化血红蛋白(HBA1c)、血脂、心肌酶学、心电图、冠状动脉造影、头颅CT或MRI检查.比较冠心病及脑梗死的患病率,对冠心病及脑梗死与各危险因子做回归分析.结果 患者第一次住院与5～10年左右再次住院比较,收缩压(DBP)、空腹血糖(FBG)、餐后2h血糖(PBG2h)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均较第一次住院时有所下降,冠心病及脑梗死患病率随着病程延长而增高.10年左右后返回住院,冠心病患者中的脑梗死患病率比无冠心病患者中的脑梗死患病率显著增高(P＜0.05).分别以冠心病和脑梗死为因变量的Logistic回归分析显示,DBP和FBG是脑梗死的危险因素,年龄是冠心病的危险因素,HDL-C是冠心病的保护性因素.结论 2型糖尿病合并的冠心病和脑梗死患病率随着病程的延长而增高,治疗10年左右冠心病与脑梗死患病率呈现出显著相关性.