产后出血临床大量用血方案的应用

发布时间：2018-03-25 09:19

本文选题：产后出血　切入点：大量输血　出处：《中国输血杂志》2015年11期

【摘要】：目的评估大量用血(MT)方案在抢救产科三级以上产后出血(PPH)的应用,同时探讨血栓弹力图技术(TEG)在凝血评估和指导临床用血的应用。方法 2014年1-12月产科三级以上PPH的患者,使用大量用血包,配比为的滤白红细胞悬液输注5 U后,滤白红细胞悬液:病毒灭活冰冰血浆:冷沉淀为1∶1∶1的比例输注,在红细胞输注15 U后,推荐使用TEG检测进行凝血检测,根据TEG参数指导进一步血液制品的使用。结果共对49名PPH产妇进行了抢救,其中前置胎盘43例,血小板减少3例,胎膜早破1例,胎盘早剥1例,羊水栓塞1例。其中45例抢救成功,1例死亡。46名产妇平均输注滤白红细胞悬液(19.64±10.54)U(8-36 U),病毒灭活冰冻血浆(12.86±18.60)U(4-34.5 U),冷沉淀(24.57±16.53)U(0-32 U)。12例患者进行了TEG检测,进行TEG检测前,平均滤白红细胞悬液输入量为13.44±5.53 U(8-19 U)病毒灭活冰冻血浆输入量为:(10.50±8.70)U(0-17 U),冷沉淀平均输入量为(10.50±8.70)U(0-17 U),对比TEG不同参数发现,对比检测正常的患者,在R值延长、Angle角缩短和MA降低的低凝患者,血浆、红细胞输入量有差异(P0.05),R值延长的患者血浆输入的比例低于的R值正常的患者。结论在产科PPH患者中,红细胞输入超过5 U后,滤白红细胞悬液:病毒灭活冰冰血浆:冷沉淀为1∶1∶1的比例可以有效的提高患者的抢救成功率。在PPH大量用血时,应用TEG检测可以及时发现患者的凝血障碍,指导血液制品使用。
[Abstract]:Objective to evaluate the application of massive blood therapy (MTT) in the treatment of postpartum hemorrhage above the third degree in obstetrics, and to explore the application of thromboelastography in the evaluation of coagulation and clinical use. Methods patients with PPH from January to December 2014 were enrolled in this study. A large number of blood bags were used. After 5 U infusion of white red blood cell suspension, the ratio of viral inactivated ice ice plasma to cold precipitate was 1:1:1. After 15 U red blood cell infusion, TEG test was recommended for coagulation detection. Results according to the TEG parameters, 49 cases of PPH were rescued, including 43 cases of placenta previa, 3 cases of thrombocytopenia, 1 case of premature rupture of membranes and 1 case of placental abruption. One case had amniotic fluid embolism. Among them, 45 cases were successfully rescued and 1 case died. The average transfusion of leucocyte suspension (19.64 卤10.54)U(8-36), viral inactivation of frozen plasma (12.86 卤18.60)U(4-34.5), cold precipitate (24.57 卤16.53)U(0-32 UU) and cold precipitation (24.57 卤16.53)U(0-32 U.12 cases) were detected by TEG. The average input amount of white red blood cell suspension was 13.44 卤5.53 UU 8-19 U) the inactivation of virus in frozen plasma was 10.50 卤8.70)U(0-17 U ~ (-1), and the average volume of cryoprecipitation was 10.50 卤8.70)U(0-17 ~ (U). Comparing with the different parameters of TEG, we found that the patients who were normal were detected comparatively. In low coagulation patients with prolonged angle angle shortening and MA decreasing, there was a difference in plasma and erythrocyte input volume in patients with lower RBC input than those with normal R value. Conclusion in obstetrical PPH patients, the RBC input is more than 5 U, and the ratio of RBC input is lower than that of normal R value (P 0.05). Conclusion in obstetrical PPH patients, the RBC input is more than 5 U. White red blood cell suspension: virus inactivated ice plasma: the ratio of cryoprecipitation to 1:1:1 can effectively improve the success rate of rescue. When PPH is used heavily, the application of TEG detection can timely discover the coagulation disorder of patients and guide the use of blood products.
【作者单位】：中国医科大学附属盛京医院;
【基金】：辽宁省省直医院重点临床科室诊疗能力建设项目(LNCCC-D13-2015)
【分类号】：R714.461

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