摘要
目的 探讨严重产后出血致弥散性血管内凝血(DIC)时血浆与红细胞的输注比值,以便制定产科DIC患者的输血方案。方法 选择2008年1月~2019年12月在本院产科分娩时因严重产后出血致DIC并成功救治的产妇共82人为研究对象,根据抢救DIC患者期间输注成分血时血浆/红细胞比值范围(0.4~2.0),按照0.4的比值间隔将纳入对象分为1组:0.4~0.8(中位数0.7,n=13);2组:>0.8~1.2(中位数1.0,n=30);3组:>1.2~1.6(中位数1.3,n=30);4组:>1.6~2.0(中位数1.8,n=9);收集4组产妇的一般情况、分娩方式、救治过程中行子宫动脉灌注栓塞术及手术的例数等资料,以及临床自产后出血起每1~2 h测定1次至病情稳定时的血常规与凝血功能指标;收集并对比4组产妇的24 h出血量、DIC期间及整个救治过程中悬浮红细胞(简称悬红)、新鲜冰冻血浆(FFP)、单采血小板、冷沉淀及纤维蛋白原输注量的记录;应用局部加权回归(Lowess)法分析FFP/悬红比值与DIC持续时间的非线性关联,对比4组产妇DIC持续时间。结果 1)DIC患者输注的血浆/悬红比值=1.8时,DIC持续时间最短(326.15 min);4组产妇DIC持续时间(min)依次为:505.21±259.53、435.67±307.18、420.93±259.43、247.86±215.77(P<0.05)。2)4组DIC产妇在输血后2.9~13.9 h,凝血指标PT(s)、INR、APTT(s)、Fib(g/L)均逐渐恢复,尤以第4组(FFP/悬红比值中位数1.8)的变化在PT、INR、Fib最为明显,分别为4.3、2.9、5 h(P<0.05)。结论 产后DIC患者抢救应尽早输注血浆,所输注的血浆/悬红比值升高且在达到1.8左右时有利于患者凝血功能尽快恢复。
Objective To investigate the transfusion ratio of plasma to RBC suspension during DIC caused by sever postpartum hemorrhage,so as to improve the clinical blood transfusion protocol.Methods A total of 82 parturients,who gave birth in our obstetrics department from January 2008 to December 2019 and treated successfully for DIC due to sever postpartum hemorrhage,were selected for the study.According to the plasma/RBC suspension ratio range(from 0.4 to 2.0) during DIC rescue,the included population was divided into four groups according to the ratio interval of 0.4:Group 1:0.4~0.8(13 people,median 0.7),Group 2:0.8~1.2(30 people,median 1.0),Group 3:1.2~1.6(30 people,median 1.3),and Group 4:1.6~2.0(9 people,median 1.8).The general conditions,way of delivery,number of uterine artery perfusion embolization and surgical operations performed in the 4 groups were recorded.Once spontaneous postpartum hemorrhage occurred,blood cell analysis and coagulation function examinations were carried out every 1 to 2 hours until the condition was stable.The 24-hour blood loss,transfusion units of RBC suspension,fresh frozen plasma(FFP),platelet apheresis and fibrinogen during DIC and throughout the rescue of 4 groups were recorded and compared.Locally Weighted Regression(Lowess) method was applied to analyze the nonlinear association between the plasma/RBC suspension ratio and the duration of DIC,according to the duration of DIC in 4 groups.Results 1) The shortest duration of DIC(326.15 min) was observed in DIC patients transfused with a plasma/red blood cell suspension ratio=1.8.The duration of DIC(min) in the four groups were 505.21±259.53,435.67±307.18,420.93±259.43,and 247.86±215.77,respectively(P<0.05).2) The coagulation indexes PT(s),INR,APTT(s) and Fib(g/L) gradually recovered between 2.9~13.9 h after transfusion in all four groups,especially in group 4(median plasma/RBC suspension ratio of 1.8),whose changes were most pronounced in PT,INR,and Fib at 4.3 h,2.9 h,and 5 h,respectively(P<0.05).Conclusion Fresh frozen plasma should be given as early as possible during blood transfusion treatment of DIC rescue.The increase of the ratio of plasma/RBC suspension is beneficial to the early recovery of DIC,and the optimal ratio of plasma to RBC suspension is 1.8.
作者
贾瑞喆
俞兆儿
姚丹
高明明
虞项
丁虹娟
JIA Ruizhe;YU Zhaoer;YAO Dan;GAO Mingming;YU Xiang;DING Hongjuan(Department of Obstetrics,Women′s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China;The Fourth School of Clinical Medicine, Nanjing Medical University)
出处
《中国输血杂志》
CAS
2022年第7期708-712,共5页
Chinese Journal of Blood Transfusion
基金
国家自然科学基金面上项目(81971393)。
关键词
弥散性血管内凝血
严重产后出血
成分输血比率
血浆
悬浮红细胞
disseminated intravascular coagulation
sever postpartum hemorrhage
component transfusion ratio
plasma
suspended RBC
