产后出血患者血液管理

Blood Management in Patients with Postpartum Hemorrhage

产后出血(PPH)是现全球范围内孕产妇死亡的主要原因之一。分娩期间一旦出现PPH,快速启动包括外科、介入、麻醉、影像、检验及输血科在内的多学科合作是最有效的抢救方案。现阶段针对PPH采取的积极的治疗措施包括精准评估失血情况,明确失血原因,采取合适的止血措施,及时有效地使用液体复苏,依据失血量及失血原因合理采用大量输血方案等。同时,氨甲环酸、纤维蛋白原等血液制品的应用逐渐受到重视。此外,有效的床旁和实验室指标监测也有助于改善PPH患者的预后。目前,依据我国孕产妇PPH的实际情况,仍需要进一步探索针对PPH合理可行的治疗策略。

Postpartum hemorrhage(PPH) is one of the leading causes of maternal mortality worldwide.If PPH occurs during childbirth,emergent collaboration is needed between several departments including surgery,interventional cardiology,anesthesia,imaging,laboratory and transfusion.Currently,several steps are considered necessary for PPH treatment:the accurate assessment of blood loss,appropriate hemostasis measures based on the specific etiology of blood loss,timely and effective fluid resuscitation,and proper massive transfusion protocols based on the cause and severity of blood loss.At the same time,tranexamic acid,fibrinogen and other blood products have gained more attention.In addition,active and timely bedside care and laboratory monitoring are also helpful to improve the prognosis.However,we still need more clinically feasible treatment strategies for PPH suitable for Chinese population.