基于系统视角的血液管理体系:从地区血液供应到临床输血决策的整合模型构建OA
A blood management system from a systemic perspective:development of an integrated model from regional blood supply to clinical transfusion decision-making
目的 为应对血液系统所面临的供需失衡、调配滞后以及临床用血不合理等系统性难题,同时弥补现有理论在整合社会动员、机构实践与政策协同方面的不足,构建 1 个从宏观到微观的系统动力学模型,以系统视角剖析血液管理体系.方法 通过系统检索中英文文献来识别关键变量,并运用改良德尔菲法,邀请不同领域专家进行专家咨询,最终筛选并确定了各子模型的核心变量集.进一步通过界定其逻辑关联,构建系统动力学模型,系统解析血液管理体系的运行机制.结果 成功提取涉及血液管理体系主要变量并构建了 4 个核心子模型:1)宏观"动态天平"模型,对地区血液供需平衡及库存调节进行量化;2)动员"三层漏斗"模型,解析社会文化、服务渠道与政策激励对献血行为转化的影响;3)机构"双环调节"模型,揭示医院用血量由疾病负荷(需求环)与血液管理(调节环)共同驱动;4)个体"三重滤网"模型,规范临床输血决策的客观必要性、风险效益与情境整合路径.最终,研究整合上述模型,提出"多层联动与反馈"整合模型,阐明了从政策环境、地区供应、社会动员、医院应用到临床决策 5 个层级间的双向传导与反馈机制.结论 构建了血液管理的系统动力学模型,通过界定关键变量与逻辑关联,系统解析了其运行机制.该整合框架贯通了地区供应、无偿献血、医院用血及临床决策等多层级,揭示了其内在联动关系.未来工作应运用系统思维,协同加强供给侧动员、需求侧管理、系统调控与决策规范化,以构建安全、高效、可持续的血液保障体系.
Objective To address systemic challenges in the blood system,such as supply-demand imbalance,ineffi-cient allocation,and inappropriate clinical use,while bridging gaps in current theories regarding the integration of social mobilization,institutional practice,and policy coordination.It sought to construct a system dynamics model spanning from macro to micro levels to analyze the blood management system holistically.Methods Key variables were identified by a systematic literature search in both Chinese and English databases.An improved Delphi method was then employed to con-duct expert consultations across different fields,leading to the selection and determination of core variable sets for each sub-model.Furthermore,by defining their logical relationships,a system dynamics model was constructed to systematically ana-lyze the operation mechanism of the blood management system.Results Four core sub-models were developed:1)A macro"Dynamic Balance"model quantifying regional supply-demand equilibrium and inventory control;2)a mobilization"Three-Layer Funnel"model analyzing how socio-cultural factors,service channels,and policy incentives influence donation behav-ior;3)an institutional"Dual-Cycle Regulation"model revealing hospital blood usage is driven by both disease burden(de-mand cycle)and management practices(regulation cycle);and 4)an individual"Three-Layer Filter"model standardizing clinical transfusion decisions based on necessity,risk-benefit,and context.These were integrated into a"Multi-Layer Link-age and Feedback"model,elucidating bidirectional interactions among five levels:policy environment,regional supply,blood station mobilization,hospital application,and clinical decision-making.Conclusion This study constructed a system dynamics model for blood management.By defining key variables and their logical relationships,it systematically analyzes the system's operational mechanism.The integrated framework connects multiple levels—regional supply,voluntary dona-tion,hospital blood use,and clinical decision-making—revealing their intrinsic linkages.Future efforts should employ sys-tems thinking to synergistically enhance supply-side mobilization,demand-side management,systemic regulation,and deci-sion standardization to build a safe,efficient,and sustainable blood security system.
朱长太;孙蕴华;张兰珺;黄龙;黎勤云;唐河山;臧艳;林俊杰;钱宝华
上海交通大学医学院附属第六人民医院 输血科,上海 200233上海市血液中心 上海市血液管理办公室,上海 200051上海市血液中心 上海市血液管理办公室,上海 200051上海交通大学医学院附属第六人民医院 输血科,上海 200233上海交通大学医学院附属第六人民医院 输血科,上海 200233海军军医大学第一附属医院 输血科,上海市临床输血质控中心 上海 200433海军军医大学第一附属医院 输血科,上海市临床输血质控中心 上海 200433上海市血液中心 上海市血液管理办公室,上海 200051海军军医大学第一附属医院 输血科,上海市临床输血质控中心 上海 200433
医药卫生
血液管理血液供应无偿献血临床用血输血决策模型
blood managementblood supplyvoluntary blood donationclinical blood usetransfusion decision-mak-ingmodel
《中国输血杂志》 2026 (6)
699-710,12
上海市卫健委2025年卫生健康政策研究课题项目(2025HP42)
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