| 關 鍵 詞： |
關節置換術；傳明酸；術後輸血率 |
| 中文摘要： |
目的：關節置換術為高齡病人常見手術，術中及術後出血量較大，輸血率偏高，易增加感染與過敏風險，並可能延長住院天數及增加護理負擔。本專案旨在提升關節置換術病人使用傳明酸（ tranexamic acid， TXA）之比例，以降低因接受手術失血而需要輸血之比率。
方法：本專案自 2023 年 4 月至 9 月於某區域教學醫院骨科病房執行。改善策略包括修訂臨床指引、將 TXA 納入術前套餐醫囑、辦理在職教育訓練、建立監測指標與報表分析機制，並於團隊會議中定期檢討成效。
結果：2023 年第 1 季至第 4 季期間，TXA 使用率由 22.3 ％提升至 74 ％。同期間，術後總失血量由 918 mL 降723
mL。2022 與 2023 年相比，輸血率由 29.6 ％降至 11.3 ％，並於 2023 年第 4 季降至 1.7％；平均住院天數由 6.1 日降至 5.6 日。
結論：透過流程標準化、教育訓練及指標監控，本專案有效提升 TXA 使用率並降低輸血率，進而改善病人安全、減輕護理負擔並降低醫療成本。
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| 英文關鍵詞： |
joint replacement surgery；tranexamic acid；postoperative transfusion rate |
| 英文摘要： |
Purpose: Joint replacement surgery is a common procedure in older adults and is often associated with major blood loss and high transfusion rates, which increase the risks of infection and allergic reactions, prolong the duration of hospitalization, and add to nursing workload. This project aimed to promote the use of tranexamic acid (TXA) in patients undergoing joint replacement surgery to mitigate the rate of transfusion required because of perioperative blood loss.
Method: This project was conducted from April to September 2023 in the orthopedic wards of a regional teaching hospital in Taiwan. Strategies included revising clinical guidelines, incorporating TXA into preoperative order sets, providing in-service education, establishing monitoring indicators with data analysis, and regularly reviewing outcomes in team meetings.
Result: The utilization rate of TXA increased from 22.3% in the first quarter of 2023 to 74% in the fourth quarter. This increase in TXA utilization was associated with a reduction in total postoperative blood loss from 918 to 723 mL. In addition, the rate of transfusion decreased from 29.6% in 2022 to 11.3% in 2023, reaching only 1.7% in the fourth quarter of 2023. Moreover, the average length of hospital stay decreased from 6.1 to 5.6 days.
Conclusion: Standardizing treatment processes, providing in-service education, and establishing monitoring indicators effectively increased the utilization rate of TXA and reduced the rate of transfusion, which in turn improved patient safety, reduced nursing workload, and lowered healthcare costs.
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前言
實施對象
方法
現況分析因素
執行期間
研究結果與討論
結論
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