产科出血及休克处理：在尼日利亚和埃及的三级保健设施中使用低技术的非充气式抗休克服。
Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities.
机构信息
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, USA.
出版信息
BMC Pregnancy Childbirth. 2010 Oct 18;10:64. doi: 10.1186/1471-2393-10-64.
BACKGROUND
Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings.
METHODS
This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression.
RESULTS
Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure <60 mmHg vs. 29.9% in the pre-intervention phase (p = 0.001). Despite this, negative outcomes were significantly reduced in the NASG phase: mean measured blood loss decreased from 444 mL to 240 mL (p < 0.001), maternal mortality decreased from 6.3% to 3.5% (RR 0.56, 95% CI 0.35-0.89), severe morbidities from 3.7% to 0.7% (RR 0.20, 95% CI 0.08-0.50), and emergency hysterectomy from 8.9% to 4.0% (RR 0.44, 0.23-0.86). In multiple logistic regression, there was a 55% reduced odds of mortality during the NASG phase (aOR 0.45, 0.27-0.77). The NNTb to prevent either mortality or severe morbidity was 18 (12-36).
CONCLUSION
Adding the NASG to standard shock and hemorrhage management may significantly improve maternal outcomes from hypovolemic shock secondary to obstetric hemorrhage at tertiary care facilities in low-resource settings.
背景
产科出血是全球产妇死亡的主要原因。非充气式抗休克服（NASG）是一种低技术的急救压缩装置，当与标准低血容量休克方案一起使用时，可能会改善资源匮乏环境中的三级医疗机构中因产科出血导致低血容量休克的女性的结局。
方法
本研究在尼日利亚的四个设施和埃及的两个设施中采用了干预前/干预设计。主要结局指标是 1442 名失血量≥750ml 且至少有一个血流动力学不稳定体征的女性的平均和中位数失血量、严重终末器官衰竭发病率（肾衰竭、呼吸衰竭、心力衰竭或 CNS 功能障碍）、死亡率和紧急子宫切除术。通过秩和检验、相对风险（RR）、需要治疗的获益人数（NNTb）和多因素逻辑回归评估研究阶段的结局比较。
结果
NASG 阶段（n=835）的女性在研究入组时的病情更差，38.5%的平均动脉压<60mmHg，而干预前阶段为 29.9%（p=0.001）。尽管如此，在 NASG 阶段，不良结局显著减少：平均测量失血量从 444ml 减少到 240ml（p<0.001），产妇死亡率从 6.3%降至 3.5%（RR 0.56，95%CI 0.35-0.89），严重发病率从 3.7%降至 0.7%（RR 0.20，95%CI 0.08-0.50），紧急子宫切除术从 8.9%降至 4.0%（RR 0.44，0.23-0.86）。多因素逻辑回归显示，在 NASG 阶段，死亡率的可能性降低了 55%（aOR 0.45，0.27-0.77）。预防死亡或严重发病率的 NNTb 为 18（12-36）。
结论
在资源匮乏环境中的三级保健设施中，将 NASG 加入标准休克和出血管理中可能会显著改善因产科出血导致的低血容量休克的产妇结局。
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