本文選題：輸血不良反應(yīng) + 電子病歷��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景輸血不良反應(yīng)是輸血過程中最常見的不良事件。盡管多數(shù)輸血不良反應(yīng)癥狀輕微,但仍可能導(dǎo)致患者醫(yī)療費(fèi)用增加或就診時(shí)間延長,對(duì)患者自身、家庭和社會(huì)造成負(fù)擔(dān);而且在極少數(shù)情況下,輸血不良反應(yīng)會(huì)導(dǎo)致患者發(fā)生嚴(yán)重的并發(fā)癥甚至死亡。因此,對(duì)輸血不良反應(yīng)的監(jiān)測受到高度重視。然而,由于醫(yī)院中輸血病例較多,如果對(duì)每一例輸血病例都進(jìn)行不良事件鑒定,對(duì)任何大型綜合醫(yī)院都不具有可操作性,因?yàn)檫@需要額外配備較多的專業(yè)人員。目前,關(guān)于輸血不良反應(yīng)的鑒定是在輸血病例的主管醫(yī)師上報(bào)的案例中展開的,由于各科室主管醫(yī)師的輸血專業(yè)知識(shí)所限或因業(yè)務(wù)繁忙而疏漏,難免出現(xiàn)誤報(bào)和漏報(bào)現(xiàn)象,從而導(dǎo)致輸血不良反應(yīng)的數(shù)據(jù)失真。鑒于此,本研究將利用醫(yī)院的電子病例系統(tǒng),通過對(duì)既往輸血病例資料的分析,試圖剝離出能夠客觀反映輸血不良反應(yīng)的特征變量,并以此為關(guān)鍵篩檢詞,經(jīng)邏輯判斷,篩選出潛在輸血不良反應(yīng)病例,交由輸血不良反應(yīng)鑒定專家委員會(huì)確認(rèn)。這樣既可以大大減輕輸血不良反應(yīng)鑒定專家委員會(huì)的工作量,又可以極大程度上減少漏報(bào)的可能,從而使輸血不良反應(yīng)的監(jiān)測既能顯著提高準(zhǔn)確性,又具有現(xiàn)實(shí)可操作性。目的提出一套基于醫(yī)院電子病歷系統(tǒng)的篩查策略用于篩檢輸血不良事件,以顯著提高輸血不良反應(yīng)監(jiān)測的準(zhǔn)確性和現(xiàn)實(shí)可操作性。研究對(duì)象以南方醫(yī)院2014年1月1日一2016年05月31日的所有住院輸血患者為研究對(duì)象,剔除重要信息不完整的病例。方法根據(jù)患者就診號(hào)和血液輸注信息確定輸血事件,運(yùn)用開發(fā)工具PowerBuilder9.0,通過結(jié)構(gòu)化查詢語言SQL,以輸血不良反應(yīng)癥狀關(guān)鍵詞為條件,在Orcal數(shù)據(jù)庫中查詢電子病歷系統(tǒng)的護(hù)理記錄和三測表記錄,篩檢記錄中輸血相關(guān)原始數(shù)據(jù),如篩檢結(jié)果不為空,初步判斷潛在輸血不良事件。再篩檢對(duì)應(yīng)輸血前、后監(jiān)測期的相關(guān)描述,結(jié)合三個(gè)時(shí)間的篩檢結(jié)果,根據(jù)體征篩檢潛在的輸血不良事件原則縮小潛在輸血不良事件范圍。在此基礎(chǔ)上搜索醫(yī)生干預(yù)措施,根據(jù)搜索結(jié)果給予篩檢潛在輸血不良事件,并將篩檢結(jié)果反饋給不良反應(yīng)鑒定專家委員會(huì)。不良反應(yīng)鑒定專家委員會(huì)針對(duì)潛在的輸血不良事件,結(jié)合患者的病程記錄、醫(yī)囑及相關(guān)檢驗(yàn)檢查等信息確認(rèn)輸血不良反應(yīng)。按輸血人次、輸血事件、輸血袋次和輸血?jiǎng)┝克姆N計(jì)量單位計(jì)算輸血反應(yīng)率,與臨床上報(bào)的輸血不良反應(yīng)率做比較。結(jié)果臨床上報(bào)的輸血不良反應(yīng)率和通過篩檢電子病歷辨識(shí)確認(rèn)輸血不良反應(yīng)率相比,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論提出一種篩查輸血不良反應(yīng)的新方法一—通過篩檢電子病歷辨識(shí)輸血不良反應(yīng)。
[Abstract]:Background adverse reactions of blood transfusion are the most common adverse events in the course of blood transfusion. Although the symptoms of most transfusions are mild, they can lead to increased medical costs or prolonged visits, placing a burden on the patients themselves, their families and society, and in very few cases, Adverse reactions to blood transfusion can lead to serious complications and even death. Therefore, the monitoring of adverse reactions to blood transfusion is highly valued. However, because of the large number of blood transfusion cases in hospitals, it is not feasible for any large general hospital if each transfusion case is identified, because it requires more professional personnel. At present, the identification of adverse reactions of blood transfusion is carried out in the cases reported by the doctors in charge of blood transfusion cases. Due to the limitation of the professional knowledge of blood transfusion of the doctors in charge of each department or the omission of the professional knowledge of the doctors in charge of blood transfusion, it is inevitable that there will be misinformation and underreporting. This results in distortion of data on adverse reactions to blood transfusions. In view of this, this study will use the electronic case system of the hospital, through the analysis of the past blood transfusion case data, try to separate out the characteristic variable which can objectively reflect the adverse reaction of blood transfusion, and take this as the key screening word, through the logic judgment, Potential adverse reaction cases of blood transfusion were screened and confirmed by the expert Committee on the Identification of adverse reactions of Blood Transfusion. In this way, the workload of the expert committee on blood transfusion adverse reaction identification can be greatly reduced, and the possibility of underreporting can be greatly reduced. Thus, the monitoring of transfusion adverse reaction can improve the accuracy significantly and have practical maneuverability. Objective to propose a screening strategy based on hospital electronic medical record system for screening transfusion adverse events, so as to improve the accuracy and practicability of blood transfusion adverse reaction monitoring. The subjects of the study were all inpatients with blood transfusion from January 1, 2014 to May 31, 2016 in Southern Hospital. Methods Blood transfusion events were determined according to the patient's visit number and blood transfusion information. Using PowerBuilder 9.0and SQL as a structured query language, the key words of adverse reaction of blood transfusion were used as the condition. The nursing records and three table records of electronic medical record system were queried in Orcal database. The original data related to blood transfusion were screened. If the screening results were not empty, the potential adverse events of blood transfusion were preliminarily judged. The relevant description of the monitoring period before and after blood transfusion and the results of screening for three times were used to reduce the scope of potential adverse events according to the principle of screening for potential adverse events of blood transfusion according to the principle of physical sign screening. On this basis, the doctor intervention measures were searched, and the potential transfusion adverse events were screened according to the search results, and the screening results were fed back to the adverse reaction appraisal expert committee. The expert Committee on adverse reactions (ADRs) confirms the adverse events of blood transfusions according to the patient's history record, doctor's advice and relevant examination information for the potential adverse events of blood transfusion. The blood transfusion reaction rate was calculated according to the four units of blood transfusion, blood transfusion events, transfusion bag times and transfusion dose, and compared with the reported adverse reaction rate of blood transfusion. Results there was significant difference between the rate of blood transfusion adverse reactions reported in clinic and the rate of blood transfusion adverse reactions confirmed by the identification of electronic medical records (P0.001). Conclusion A new method for screening adverse reactions of blood transfusion is proposed.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R457.1;R197.3

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