产后出血临床大量用血方案的应用  

Massive transfusion protocol application in postpartum hemorrhage

作　　者：邢准[1] 王秋实[1] 杨巧妮[1] 赵平[1] 刘彩霞[1] 宋薇薇[1] 

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004

出　　处：《中国输血杂志》2015年第11期1381-1385,共5页Chinese Journal of Blood Transfusion

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)

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(P<0.05),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。Objective To evaluate the application of massive transfusion protocol in rescue severe postpartum hemorrhage（ PPH）,to explore the application of thromboelastography（ TEG） in the evaluation of blood coagulation and to guide blood usage. Methods From January to December 2014,the MT protocol was used in the PPH patients at three levels,once after5 infusion units of leukocyte-reduced red blood cells,the following blood components（ leukocyte-reduced red blood cell suspension,virus inactivated frozen plasma,cryoprecipitate） were infused in a ratio of 1∶ 1∶ 1. After 15 units of leukocyte- reduced red blood cells were infused,TEG detection was recommended. Results A total of 49 maternal rescues were conducted,including 44 cases of placenta previa,3 cases of thrombocytopenia,1 case of premature rupture of membranes,1 case of placental abruption and 1 case of amniotic fluid embolism. 45 cases were successfully rescued,but 1 died of amniotic fluid embolism. An average amount of infusion was was（ 19. 64 ±10. 54） U（ 8- 36 U） for white and red blood cell suspension,（ 12. 86 ± 18. 60） U（ 4- 34. 5 U） for virus inactivated frozen plasma,and 24. 57 ± 16. 53 U（ 0- 32 U） for cryoprecipitate. Before detection of TEG,the average infusion amount of leukocyte- reduced red blood cells was（ 13. 44 ± 5. 53） U（ 8- 19 U）,the average input of virus inactivated frozen plasma was（ 10. 50 ± 8. 70） U（ 0- 17 U）,and the average input of cryoprecipitate was（ 10. 50 ± 8. 70） U（ 0- 17 U）. When comparing the different TEG parameters,in patients with lengthened R,shortened angle and reduced MA,significant statistical difference is found in the infusion of plasma and red blood cells among these patients and the normal patients（ P〈 0. 05）. Patients with higher R value received more plasma infusion. Conclusion In obestric PPH cases,after infusion of 5u of red blood cells,infusing leukocyte- reduced red blood cell suspension,virus inactivated frozen plasma and cryoprecipitate in a 1∶

关 键 词：产后出血 大量输血 血栓弹力图 

分 类 号：R457.1[医药卫生—治疗学] R714.461[医药卫生—临床医学]