产科大量输血方案的临床研究进展  

Clinical research progress related to massive blood transfusion in obstetrics

作　　者：丁洁岚[1] 冯娟[1] 陈皆锋[1] 潘海滔 DING Jie-lan;FENG Juan;CHEN Jie-feng;PAN Hai-tao(Department of Anesthesiology,Shaoxing Maternity and Child Health Care Hospital,Shaoxing,Zhejiang 312000,China;不详)

机构地区：[1]绍兴市妇幼保健院麻醉科,浙江绍兴312000 [2]绍兴市妇幼保健院医学研究与成果转化中心

出　　处：《中华全科医学》2022年第3期468-472,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2019RC296);绍兴市科技计划项目(2018C30041)。

摘　　要：产科大量输血,即意味着产科大出血,需要产科、麻醉和血库团队的广泛协调。在临床过程中,产后出血是目前产科主要的并发症,产科大出血是孕产妇死亡的主要原因之一,不管是术中还是产后出血都将对产妇造成一定的威胁,给临床医生带来极大的挑战。因此及时识别产科大量输血的风险因素,能为有效救治带来更多的机会与把握,提高产妇的生存率。输血仍然是产科大出血抢救时最重要的治疗方法,然而输血不慎也可能带来严重的后果。大量输血方案(massive transfusion protocols,MTP)是指在大出血时,按照预先制定的血液成分方案予以输血,MTP是一个有预见性的输血方案,是应对产科大量失血时,在及时补充红细胞的同时,有预见性的补充血浆、凝血因子、血小板等,以纠正凝血功能障碍。MTP不仅包括输入的量,还是一个应急联动机制。同时对血液成分进行合理配备,也对输血中的各项事宜制定了明确的管理细则,使得血液成分的供应更为有效。抢救过程中医护人员遵循规范,规范输血策略,及时把握产科大量输血的启动时机,迅速采用合适比例进行快速输血,应对大量输血带来的危急状况,快速促进产妇血容量恢复,这也是救治过程中的重要环节,对提高抢救成功率有着极其重要的意义。In obstetrics,obstetric mass transfusion requires extensive coordination amongst obstetric,anaesthesia and blood bank teams.In the clinical process,obstetric haemorrhage is one of the most common causes of obstetric morbidity and mortality.Intraoperative and postpartum haemorrhage will pose a certain threat to the puerpera and bring great challenges to clinicians.Therefore,timely identification of risk factors for obstetric massive transfusion can bring more opportunities for treatment and improve the survival rate of puerpera.Blood transfusion is still the most important treatment in the rescue of obstetric haemorrhage,but careless blood transfusion will bring serious consequences.Massive transfusion protocols(MTP)is a predictive blood transfusion protocol,which is used to correct the coagulation dysfunction by adding plasma,clotting factors and platelets,even when red blood cells are added in response to massive blood loss in obstetrics.MTP not only includes the amount of input,but also is an emergency linkage mechanism.Reasonable allocation of blood components and clear management rules for various matters in blood transfusion have been formulated to make the supply of blood components more effective.In the process of the rescue,staff should follow the specification,standard blood transfusion strategy,timely grasp the obstetric numerous transfusions start time,quick to adopt appropriate proportion of rapid blood transfusion,deal with a large number of blood transfusions of critical condition,recovery quickly promote maternal blood volume.This is the important link in the process of treatment,which is of extremely important significance to improve the success rate of rescue.

关 键 词：产科 大量输血方案 风险因素 并发症 

分 类 号：R714[医药卫生—妇产科学] R457.1[医药卫生—临床医学]