Baudo F, Caimi T M, Mostarda G, de Cataldo F, Morra E
Unit of Thrombosis and Hemostasis, Department of Hematology, Niguarda Hospital, Milan, Italy.
Minerva Anestesiol. 2006 Jun;72(6):389-93.
In the developed countries the frequency of life threatening post-partum hemorrhages (PPH) is 1 in 1,000 deliveries with a risk of death of 1-2/100,000 deliveries. Hysterectomies for intractable bleeding are carried out in approximately 50% of the cases. The majority of PPH have obstetrical causes, most frequently atony of the uterus. Hereditary and acquired hemostatic defects are very rare. Guidelines of standard surgical and medical measures are available. In this paper we focus on the use of activated recombinant factor VII (rFVIIa) in PPH.
A computerized literature search was carried out in PubMed and Ovid for papers published between 2001 and 2005 in the English literature reporting on life-threatening PPH treated with rFVIIa after failure of conventional therapy, including hysterectomy.
We identified 11 papers including 39 patients; in 18 of them the laboratory data were indicative for disseminated intravascular coagulation and in 24 hysterectomy was carried out. Controlled or reduced bleeding was reported in 38 out of 39 treated patients.
The bleeding can occur in a series of events conductive to metabolic complications, hypoxia, disseminate intravascular coagulation, organ damage and multiorgan failure, progressively exhaustive. The therapeutic intervention must be instituted as early as possible before successive complications ensue. These preliminary reports in PPH after failure of conventional standard therapy suggest that rFVIIa is an active agent but should be administered as early as possible before the consequences of severe and intractable bleeding.
在发达国家，危及生命的产后出血（PPH）发生率为每1000例分娩中有1例，死亡风险为每10万例分娩中有1 - 2例。约50%的病例因难治性出血而行子宫切除术。大多数PPH由产科原因引起，最常见的是子宫收缩乏力。遗传性和获得性止血缺陷非常罕见。有标准的手术和药物治疗指南。在本文中，我们重点关注重组活化因子VII（rFVIIa）在PPH中的应用。
在PubMed和Ovid上进行计算机文献检索，查找2001年至2005年期间发表的英文文献，这些文献报道了常规治疗（包括子宫切除术）失败后用rFVIIa治疗危及生命的PPH的情况。
我们确定了11篇论文，共39例患者；其中18例实验室数据提示弥散性血管内凝血，24例行子宫切除术。39例接受治疗的患者中有38例报告出血得到控制或减少。
出血可发生在一系列导致代谢并发症、缺氧、弥散性血管内凝血、器官损伤和多器官功能衰竭的事件中，逐渐消耗殆尽。必须在连续并发症发生之前尽早进行治疗干预。这些关于常规标准治疗失败后PPH的初步报告表明，rFVIIa是一种有效的药物，但应在严重难治性出血的后果出现之前尽早给药。
