产科大量输血方案的临床研究进展

丁洁岚; 冯娟; 陈皆锋; 潘海滔

doi:10.16766/j.cnki.issn.1674-4152.002380

产科大量输血方案的临床研究进展

doi: 10.16766/j.cnki.issn.1674-4152.002380

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

基金项目:

浙江省医药卫生科技计划项目 2019RC296

绍兴市科技计划项目 2018C30041

详细信息

通讯作者:
丁洁岚，E-mail：ng741236@163.com

中图分类号: R714 R457.1
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- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2021-10-13
- 网络出版日期: 2022-08-13

Clinical research progress related to massive blood transfusion in obstetrics

1.
Department of Anesthesiology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, Zhejiang 312000, China

摘要

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。
- 产科 /
- 大量输血方案 /
- 风险因素 /
- 并发症
Abstract: 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.
- Department of Obstetrics /
- Massive transfusion protocols /
- Risk factors /
- Complication

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参考文献(37)

[1]	YANG J C, WANG Q S, DANG Q L, et al. Investigation of the status quo of massive blood transfusion in China and a synopsis of the proposed guidelines for massive blood transfusion[J]. Medicine(Baltimore), 2017, 96(31): e7690. DOI: 10.1097/MD.0000000000007690.
[2]	TRIKHA A, SINGH P M. Management of major obstetric haemorrhage[J]. Indian J Anaesth, 2018, 62(9): 698-703. doi: 10.4103/ija.IJA_448_18
[3]	O'BRIEN K L, SHAINKER S A, LOCKHART E L. Transfusion Management of obstetric hemorrhage[J]. Transfus Med Rev, 2018, 32(4): 249-255. doi: 10.1016/j.tmrv.2018.05.003
[4]	HUTCHEON J A, CHAPINAL N, SKOLL A, et al. Inter-hospital variation in use of obstetrical blood transfusion: A population-based cohort study[J]. BJOG, 2020, 127(11): 1392-1398. doi: 10.1111/1471-0528.16203
[5]	THURN L, WIKMAN A, WESTGREN M, et al. Massive blood transfusion in relation to delivery: Incidence, trends, and risk factors: A population-based cohort study[J]. BJOG, 2019, 126(13): 1577-1586. doi: 10.1111/1471-0528.15927
[6]	AHMADZIA H K, PHILLIPS J M, JAMES A H, et al. Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model[J]. PLoS One, 2018, 13(12): e0208417. DOI: 10.1371/journal.pone.0208417.
[7]	VANDERMEULEN H, STRAUSS R, LIN Y, et al. The contribution of iron deficiency to the risk of peripartum transfusion: A retrospective case control study[J]. BMC Pregnancy Childbirth, 2020, 20(1): 196. doi: 10.1186/s12884-020-02886-z
[8]	OUH Y T, LEE K M, AHN K H, et al. Predicting peripartum blood transfusion: Focusing on pre-pregnancy characteristics[J]. BMC Pregnancy Childbirth, 2019, 19(1): 477. doi: 10.1186/s12884-019-2646-3
[9]	BLOCH E M, INGRAM C, HULL J, et al. Risk factors for peripartum blood transfusion in South Africa: A case-control study[J]. Transfusion, 2018, 58(9): 2149-2156. doi: 10.1111/trf.14772
[10]	MHYRE J M, SHILKRUT A, KUKLINA E V, et al. Massive blood transfusion during hospitalization for delivery in New York State, 1998-2007[J]. Obstet Gynecol, 2013, 122(6): 1288-1294. doi: 10.1097/AOG.0000000000000021
[11]	THURN L, WIKMAN A, LINDQVIST P G. Postpartum blood transfusion and hemorrhage as independent risk factors for venous thromboembolism[J]. Thromb Res, 2018, 165: 54-60. doi: 10.1016/j.thromres.2018.03.002
[12]	SHON C H, KIM Y J, SEO D W, et al. Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage[J]. Br J Anaesth, 2018, 121(2): 378-383. doi: 10.1016/j.bja.2018.04.039
[13]	SHAMSHIRSAZ A A, FOX K A, ERFANI H, et al. Multidisciplinary team learning in the management of the morbidly adherent placenta: Outcome improvements overtime[J]. Am J Obstet Gynecol, 2017, 216(6): 612. e1-612. e5. DOI: 10.1016/j.ajog.2017.02.016.
[14]	MAVRIDES E, ALLARD S, CHANDRAHARAN E, et al. Prevention and management of postpartum haemorrhage[J]. BJOG, 2017, 216(6): 612.
[15]	PRASAD M, SAADE G R, SANDOVAL G, et al. Hepatitis C virus antibody screening in a cohort of pregnant women: Identifying seroprevalence and risk factors[J]. Obstet Gynecol, 2020, 135(4): 778-788. doi: 10.1097/AOG.0000000000003754
[16]	VOLHECK G W, HEPNER D L. Identification and management of perioperative anaphylaxis[J]. J Allergy Clin Immunol Pract, 2019, 7(7): 2134-2142. doi: 10.1016/j.jaip.2019.05.033
[17]	LIO C F, LEE Y H, CHAN H Y, et al. Posterior reversible encephalopathy syndrome in a postpartum hemorrhagic woman without hypertension: A case report[J]. Medicine, 2017, 96(16): e6690. DOI: 10.1097/MD.0000000000006690.
[18]	AGERGARD C N, HAUNSTRUP T M, FJORDSIDE A L, et al. Severe antibody-mediated transfusion-related acute lung injury in an obstetric patient following transfusion of fresh frozen plasma from a non-transfused male blood donor[J]. Clin Case Rep, 2021, 9(6): e03818. DOI: 10.1002/ccr3.3818.
[19]	WANG C, LE RAY I, LEE B, et al. Association of blood group and red blood cell transfusion with the incidence of antepartum, peripartum and postpartum venous thromboembolism[J]. Sci Rep, 2019, 9(1): 13535. doi: 10.1038/s41598-019-49566-3
[20]	CALI G, FORLANI F, TIMOR-TRISCH I, et al. Diagnostic accuracy of ultrasound in detecting the depth of invasion in women at risk of abnormally invasive placenta: A prospective longitudinal study[J]. Acta Obstet Gynecol Scand, 2018, 97(10): 1219-1227. doi: 10.1111/aogs.13389
[21]	DOBSON G, CHONG M, CHOW L, et al. Guidelines to the practice of Anesthesia-Revised Edition 2017[J]. Can J Anaesth, 2017, 64(1): 65-91. doi: 10.1007/s12630-016-0749-0
[22]	JIAO C, ZHENG L. Blood transfusion-related immunomodulation in patients with major obstetric haemorrhage[J]. Vox Sang, 2019, 114(8): 861-868. doi: 10.1111/vox.12845
[23]	PATTERSON J A, NIPPITA T A, RANDALL D, et al. Outcomes associated with transfusion in low-risk women with obstetric haemorrhage[J]. Vox Sang, 2018, 113(7): 678-685. doi: 10.1111/vox.12707
[24]	LEVI M, LEVI J H. Role of blood transfusion in obstetrics[J]. Trop J Obstet Gynaecol, 2019, 36(3): 223-228.
[25]	NAPOLITANO L M. Hemostatic defects in massive transfusion: An update and treatment recommendations[J]. Expert Rev Hematol, 2021, 14(2): 219-239. doi: 10.1080/17474086.2021.1858788
[26]	TANAKA H, MATSUNAGA S, YAMASHITA T, et al. A systematic review of massive transfusion protocol in obstetrics[J]. Taiwan J Obstet Gynecol, 2017, 56(6): 715-718. doi: 10.1016/j.tjog.2017.10.001
[27]	NUNEZ T C, VOSKRESENSKY I V, DOSSETT L A, et al. Early prediction of massive transfusion in trauma: Simple as ABC (assessment of blood consumption)?[J]. J Trauma, 2019, 66(2): 346-352.
[28]	PACHECO L D, SAADE G R, COSTANTINE M M, et al. An update on the use of massive transfusion protocols in obstetrics[J]. Am J Obstet Gynecol, 2016, 214(3): 340-344. doi: 10.1016/j.ajog.2015.08.068
[29]	SNEGOVSKIKN D, SOUZA D, WALTON Z, et al. Point-of-care viscoelastic testing improves the outcome of pregnancies complicated by severe postpartum hemorrhage[J]. J Clin Anesth, 2018, 44: 50-56. doi: 10.1016/j.jclinane.2017.10.003
[30]	PHAM H P, SHAZ B H. Update on massive transfusion[J]. Br J Anaesth, 2013, 111(Suppl 1): i71-82.
[31]	MUÑOZ M, STENSBALLE J, DUCLOY-BOUTHORS A S, et al. Patient blood management in obstetrics: Prevention and treatment of postpartum haemorrhage. A NATA consensus statement[J]. Blood Transfus, 2019, 17(2): 112-136.
[32]	BUTWICK A J, GOODNOUGH L T. An updated report by the American Society of Anesthesiologists task force on obstetric Anesthesia and the Society for obstetric anesthesia and perinatology[J]. Obstetric Anesthesia Digest, 2016, 36(4): 152-155.
[33]	TREML A B, GORLIN J B, DUTTON R P, et al. Massive Transfusion protocols: A survey of academic medical centers in the United States[J]. Aneth Analg, 2017, 124(1): 277-281. doi: 10.1213/ANE.0000000000001610
[34]	SURBEK D, VIAL Y, GIRARD T, et al. Patient blood management (PBM) in pregnancy and childbirth: Literature review and expert opinion[J]. Arch Gynecol Obstet, 2019, 301(2): 627-641.
[35]	KOZEK-LANGENECKER S A, AHMED A B, AFSHARI A, et al. Management of severe perioperative bleeding: Guidelines from the European Society of Anaesthesiology: First update 2016[J]. Eur J Anaesthesiol, 2017, 34(6): 332-395. doi: 10.1097/EJA.0000000000000630
[36]	余旭琦, 陈俊妍, 严海雅. 产科回收式自体输血的研究进展和应用[J]. 中国输血杂志, 2018, 31(5): 568-572. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201805048.htm YU X Q, CHEN J Y, YAN H Y. The clinical application experience and research progress in IOCS in obstetrics[J]. Chinese Journal of Blood Transfusion, 2018, 31(5): 568-572. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201805048.htm
[37]	胡如雪, 徐坚强, 卢根杰. 预存联合术中回收式自体输血对择期手术患者的临床研究[J]. 中华全科医学, 2017, 15(6): 1065-1068. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.046 HU R X, XU J Q, LU G J. Clinical study of preconditioned combined intraoperative recovering autologous blood transfusion in patients with elective surgery[J]. Chinese Journal of General Practice, 2017, 15(6): 1065-1068. doi: 10.16766/j.cnki.issn.1674-4152.2017.06.046