回收式自体输血在产科中应用.pdfVIP

回收式自体输血 在产科中的应用 宁波市妇女儿童医院麻醉科 严海雅 产科出血 • 产科出血是导致世界孕产妇死亡的第一位因素！！ • 产科出血存在一定的不可预计性！！ B-lynch缝合 出血1500ml 外院错误的B- lynch缝合 二进宫，累计出血5000ml 术中出血3500ml 出血20000ml 保留子宫，术后MTX、子宫动脉栓塞 回收式自体输血储血罐 和吸引器瓶仅见及少量出血 资料来源 Epidemiology-流行病学 1、Maternal hemorrhage complicates approximately 3% of all deliveries. 孕产妇出血发生率3% 2 、Postpartum hemorrhage (PPH) is increasing in developed countries around the globe. 全球发达国家产后出血发生率不断上升 3、In the U.S., between 1994 and 2006, rates of PPH increased 30%, and the proportion of all U.S.deliveries complicated by a blood transfusion increased 90% (from 2.4 to 4.6 per 1,000 deliveries) between 1998 and 2005. 美国，从1994年至2006年，产后出血发生率上升了30%，分 娩需要输血的比例增加了90% （从2.4/1000上升到4.6/1000）。 产科出血上万还是有一定发生几率！ With placenta accreta, the decidua basalis (i.e., the decidual basal plate)is absent, and the placenta adheres to a floor of uterine myometrium. With placenta increta, chorionic villi invade into the myometrium, and with percreta, the placenta penetrates the uterine serosa, and may even grow into other pelvic structures, most commonly the bladder. Estimated intrapartum blood loss has been reported as 2L in 66%,5L in 15%, and 10L in 6.5% of these cases. 胎盘植入可以穿透子宫浆膜层，侵入盆腔其它组织，常见为 膀胱，报道的估计出血量：2L 66% ，5L 15%, 10L 6.5% 容量替代治疗原则 Volume loss (%) 100 90 80 70 60 50 40 30 20 10 0 晶+胶Colloids + crystalloids + 红细胞 +新鲜冰冻血浆 + 血小板 Target controlled replacement 自体输血概况 我院自体输血实施情况 2008 2009 2010 2011 2012 2013 自体输血总例数 168 155 124 134 237 432 自体输血总量 85947 73978 60709