产科实践中减少血液制品使用的策略Strategiestoreduceblood.PDFVIP

产科实践中减少血液制品使用的策略 Strategies to reduce blood product utilization in obstetric practice 译 者：佘玉琦 【摘要】目的：患者的血液管理（PBM）旨在通过减少不必要的 RBC 输血并激活患者特 异性贫血铁储备来改善患者的结局和安全性。虽然 PBM 广泛的被认为是择期手术中最好的 临床实践，但 PBM 的实施在产科中受到限制。本综述总结了在产科实践中减少血液制品利 用的最新发现。现状：在产科医学领域应迫切采用基于 PBM 相关的循证优势。静脉注射铁 被认为是补充铁储备并纠正妊娠相关和出血相关的缺铁性贫血的安全有效的策略。除了手 术技术和使用子宫收缩剂外，在存在出血的情况下，最近的研究支持早期使用凝血酸，纤 维蛋白原和凝血因子浓缩物，粘弹性引导实践，用于治疗凝血病。剖宫产患者中，自体红 细胞血液补救可能会减少血液制品的使用，尽管在这种情况下它的使用是有争议的。结论： 在产科实践中实施 PBM 对减少失血量和异体血制品的输血要求提供了很大的潜力，尽管在 这一领域缺乏大量的临床试验。增加静脉注射铁，可增加围产期血红蛋白水平。此外，凝 血酸和凝血因子辅助治疗是减少产科不必要的失血和输血的有效方法。 【关键词】输血，止血技术，缺铁性贫血，患者血液管理，产后出血 原始文献摘要 Holger Neb, Kai Zacharowski, and Patrick Meybohm,Strategies to reduce blood product utilization in obstetric practice.Curr Opin Anaesthesiol. 2017 Jun;30(3):294-299.doi: 10.1097/ACO. 0000000000000463. Abstract ： Purpose of review Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. Recent findings PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell