本文選題：產后出血　切入點：大量輸血　出處：《中國輸血雜志》2015年11期

【摘要】：目的評估大量用血(MT)方案在搶救產科三級以上產后出血(PPH)的應用,同時探討血栓彈力圖技術(TEG)在凝血評估和指導臨床用血的應用。方法 2014年1-12月產科三級以上PPH的患者,使用大量用血包,配比為的濾白紅細胞懸液輸注5 U后,濾白紅細胞懸液:病毒滅活冰冰血漿:冷沉淀為1∶1∶1的比例輸注,在紅細胞輸注15 U后,推薦使用TEG檢測進行凝血檢測,根據TEG參數指導進一步血液制品的使用。結果共對49名PPH產婦進行了搶救,其中前置胎盤43例,血小板減少3例,胎膜早破1例,胎盤早剝1例,羊水栓塞1例。其中45例搶救成功,1例死亡。46名產婦平均輸注濾白紅細胞懸液(19.64±10.54)U(8-36 U),病毒滅活冰凍血漿(12.86±18.60)U(4-34.5 U),冷沉淀(24.57±16.53)U(0-32 U)。12例患者進行了TEG檢測,進行TEG檢測前,平均濾白紅細胞懸液輸入量為13.44±5.53 U(8-19 U)病毒滅活冰凍血漿輸入量為:(10.50±8.70)U(0-17 U),冷沉淀平均輸入量為(10.50±8.70)U(0-17 U),對比TEG不同參數發(fā)現,對比檢測正常的患者,在R值延長、Angle角縮短和MA降低的低凝患者,血漿、紅細胞輸入量有差異(P0.05),R值延長的患者血漿輸入的比例低于的R值正常的患者。結論在產科PPH患者中,紅細胞輸入超過5 U后,濾白紅細胞懸液:病毒滅活冰冰血漿:冷沉淀為1∶1∶1的比例可以有效的提高患者的搶救成功率。在PPH大量用血時,應用TEG檢測可以及時發(fā)現患者的凝血障礙,指導血液制品使用。
[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 鹵10.54)U(8-36), viral inactivation of frozen plasma (12.86 鹵18.60)U(4-34.5), cold precipitate (24.57 鹵16.53)U(0-32 UU) and cold precipitation (24.57 鹵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 鹵5.53 UU 8-19 U) the inactivation of virus in frozen plasma was 10.50 鹵8.70)U(0-17 U ~ (-1), and the average volume of cryoprecipitation was 10.50 鹵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.
【作者單位】： 中國醫(yī)科大學附屬盛京醫(yī)院;
【基金】：遼寧省省直醫(yī)院重點臨床科室診療能力建設項目(LNCCC-D13-2015)
【分類號】：R714.461

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