Département d'Anesthésie Réanimation, Hôpital Antoine Béclère, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique-Hôpitaux de Paris, Université Paris XI, Clamart, France.
Curr Opin Anaesthesiol. 2010 Jun;23(3):310-6. doi: 10.1097/ACO.0b013e32833835a2.
To guide the optimal use of blood products and to clarify the indications for prohemostatic drugs in obstetric hemorrhage.
The literature emphasizes the usefulness of transfusing packed red blood cells, fresh frozen plasma and platelets earlier and in defined ratios to prevent dilutional coagulopathy during obstetric hemorrhage. The value of fibrinogen concentrate and prohemostatic drugs such as tranexamic acid and recombinant factor VIIa is also pointed out.
It seems reasonable to use blood products for transfusion earlier and in a 1: 1 fresh frozen plasma: red blood cell ratio during acute obstetric hemorrhage; however, this analysis is mainly based on trauma literature. Fibrinogen concentrate should be added if the fibrinogen plasma level remains below 1.0 g l(-1) and perhaps even as soon as it falls below 1.5-2.0 g l(-1); the addition of tranexamic acid (1 g) is cheap, likely to be useful and appears safe. Data on the proactive administration of platelets are insufficient to recommend this practice routinely. Presently, recombinant factor VIIa (60-90 microg kg(-1)) is advocated only after failure of other conventional therapies, including embolization or conservative surgery, but prior to obstetric hysterectomy. Prospective randomized controlled trials are highly desirable.
指导血液制品的最佳使用，并阐明产科出血中抗纤溶剂药物的适应证。
文献强调了在产科出血期间，为预防稀释性凝血功能障碍，更早地以特定比例输注浓缩红细胞、新鲜冷冻血浆和血小板的重要性。纤维蛋白原浓缩物和抗纤溶剂如氨甲环酸和重组 VII 因子的作用也得到了强调。
在急性产科出血期间，似乎可以合理地更早地输注血液制品，并以 1:1 的新鲜冷冻血浆：红细胞比例进行输血；然而，这种分析主要基于创伤文献。如果纤维蛋白原血浆水平仍低于 1.0 g/L(-1)，甚至可能在其降至 1.5-2.0 g/L(-1)以下时，就应添加纤维蛋白原浓缩物；添加氨甲环酸（1 g）便宜、可能有用且似乎安全。关于积极给予血小板的数据不足以推荐常规应用这种方法。目前，仅在其他常规治疗（包括栓塞或保守手术）失败后，以及在产科子宫切除术之前，才提倡使用重组 VII 因子（60-90 μg/kg(-1))。非常需要前瞻性随机对照试验。
