大量输血方案在严重产后出血中的应用探讨

doi:10.3969/j.issn.1671-2587.2021.05.012

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (5): 604-607.DOI: 10.3969/j.issn.1671-2587.2021.05.012

• 妇产科儿科输血专题（一） • 上一篇下一篇

大量输血方案在严重产后出血中的应用探讨

耿文艳, 罗冰, 李晓丹, 肖晴, 黄小亭, 毛曼

510150 广州医科大学附属第三医院

收稿日期:2021-07-06 发布日期:2021-10-20
通讯作者: 罗冰,女,主任医师,学士,主要从事临床血液病与输血治疗研究,（E-mail）luobing714@163.com。
作者简介:耿文艳（1986-）,女,山西汾阳人,主管技师,硕士,主要从事临床输血、血小板拓展应用的研究 ,（E-mail）gengwenyan0305@163.com。

Massive Transfusion Protocols in Severe Postpartum Hemorrhage Practice

GENG Wen-yan, LUO Bing, LI Xiao-dan, et al

Department of Transfusion,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150

Received:2021-07-06 Published:2021-10-20

摘要/Abstract

摘要： 目的探讨产后大量输血时不同血液制剂的最佳应用比例。方法对2018年5月~2021年4月在广州医科大学附属第三医院产科实行大量输血方案的所有患者进行回顾性分析,收集包括患者一般情况、产后出血病因、出血量、输注的血液制剂品种和数量,以及患者转归等资料。结果胎盘因素是导致产后大出血的主要原因（84%）,其中69%因胎盘植入所致。100例产后大出血患者接受了大量输血方案,其中84例患者的出血情况得到很好控制。纳入研究的患者平均出血量为（2 778±1 253）mL,分别输注红细胞（8.6±4.7）U、新鲜冰冻血浆（543±334）mL、普通冰冻血浆（352±343）mL。5组接受大量输血方案治疗的产后大出血患者中,第1组（即红细胞:血浆=1∶1）与第3组（即红细胞∶血浆=6∶4）输血有效率较高,分别为96.88 %与94.12 %。结论合理的大量输血方案是治疗产后大出血的重要手段,首先推荐红细胞与血浆为1∶1方案,其次是红细胞与血浆为6∶4方案,有条件应尽早搭配使用血小板和/或冷沉淀。

关键词: 产后出血, 大量输血, 凝血功能障碍

Abstract: Objective To explore optimizing transfusion ratios of different blood products in postpartum hemorrhage requiring massive blood transfusion (MT). Methods A retrospective study was performed using data from all patients who underwent a MT in the Obstetrics Department of the Third Affiliated Hospital of Guangzhou Medical University from May 2018 to April 2021. The information including patient's general condition, cause of postpartum hemorrhage, amount of blood loss, amount of blood products and patient outcomes were collected. Results Placental factors was the main cause of postpartum hemorrhage (84.00%), of which 69.00% was caused by placenta accreta. One hundred patients with postpartum hemorrhage received a MT, and the bleeding of 84 patients were well controlled. The mean estimated blood loss was 2 778 mL. Each patient required blood transfusion at a mean of 8.6 units of packed red blood cells, 543 mL of fresh frozen plasma and 352 mL of frozen plasma. Among the five groups of patients with postpartum hemorrhage who received MT, group 1 (red blood cell∶plasma=1∶1) and group 3 (red blood cell∶plasma=6∶4) had the highest blood transfusion efficiency (96.88%, 94.12%). Conclusion A reasonable mass transfusion program is an important treatment for postpartum hemorrhage. A 1∶1 program of red blood cells and plasma is recommended, then 6∶4 program of platelets and/or cryoprecipitate should be given as early as possible.

Key words: Postpartum hemorrhage, Massive transfusion, Coagulation dysfunction

中图分类号:

R714.46⁺1

耿文艳, 罗冰, 李晓丹, 肖晴, 黄小亭, 毛曼. 大量输血方案在严重产后出血中的应用探讨[J]. 临床输血与检验, 2021, 23(5): 604-607.

GENG Wen-yan, LUO Bing, LI Xiao-dan, et al. Massive Transfusion Protocols in Severe Postpartum Hemorrhage Practice[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(5): 604-607.

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大量输血方案在严重产后出血中的应用探讨

Massive Transfusion Protocols in Severe Postpartum Hemorrhage Practice

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