Kerr Nancy L, Hauswald Mark, Tamrakar Suman Raj, Wachter David A, Baty Gillian M
Department of Emergency Medicine, University of New Mexico, MSC 11 6025, 1 University of New Mexico, Mexico 87131, USA.
BMC Pregnancy Childbirth. 2014 Feb 24;14:81. doi: 10.1186/1471-2393-14-81.
Obstetric hemorrhage remains the leading cause of maternal mortality in resource limited areas. An inexpensive pneumatic anti-shock garment was devised of bicycle tubes and tailored cloth which can be prepared from local materials in resource-limited settings. The main purposes of this study were: 1) to determine acceptability of the device by nurses and midwives and obtain suggestions for making the device more suitable for use in their particular work environments, 2) to determine whether a three hour training course provided adequate instruction in the use of this device for the application of circumferential abdominal pelvic pressure, and 3) determine production capability and cost in a resource-limited country.
Fifty-eight nurse and midwife participants took part in three sessions over eight months in Nepal. Correct device placement was assessed on non-pregnant participants using ultrasound measurement of distal aortic flow before and after device inflation, and analyzed using confidence intervals. Participants were surveyed to determine acceptability of the device, obtain suggestions for improvement, and to collect data on clinical use.
Device placement achieved flow decreases with a mean of 39% (95% CI 25%-53%, p < 0.001) in the first session, 28% (95% CI 21%-33%, P < 0.001) after four months and 29% (95% CI 24%-34%, p < 0.001) at 8 months. All nurses and midwives thought the device would be acceptable for use in obstetric hemorrhage and that they could make, clean, and apply it. They quickly learned to apply the device, remembered how to apply it, and were willing and able to use the device clinically. Ten providers used the device, each on one patient, to treat obstetric hemorrhage after routine measures had failed; bleeding stopped promptly in all ten, two of whom were transported to the hospital. Production of devices in Kathmandu using local tailors and supplies cost approximately $40 per device, in a limited production setting.
Preliminary data suggest that an inexpensive, easily-made device is potentially an appropriate addition to current obstetric hemorrhage treatment in resource-limited areas and that further study is warranted.
在资源有限的地区，产科出血仍然是孕产妇死亡的主要原因。一种由自行车内胎和特制布料制成的廉价气动抗休克服，可在资源有限的环境中利用当地材料制作。本研究的主要目的是：1）确定护士和助产士对该设备的接受程度，并获取使该设备更适合在其特定工作环境中使用的建议；2）确定为期三小时的培训课程是否能为使用该设备施加腹部盆腔环形压力提供充分的指导；3）确定在一个资源有限的国家的生产能力和成本。
58名护士和助产士参与者在尼泊尔的八个月内参加了三个阶段的研究。通过超声测量非孕妇参与者在设备充气前后的远端主动脉血流来评估设备的正确放置情况，并使用置信区间进行分析。对参与者进行调查，以确定该设备的可接受性，获取改进建议，并收集临床使用数据。
在第一阶段，设备放置使血流平均减少39%（95%置信区间25%-53%，p<0.001），四个月后减少28%（95%置信区间21%-33%，P<0.001），八个月时减少29%（95%置信区间24%-34%）。所有护士和助产士都认为该设备可用于产科出血，并且他们能够制作、清洁和使用它。他们很快学会了使用该设备，记住了如何使用它，并且愿意并能够在临床上使用该设备。十名医护人员在常规措施失败后，每人对一名患者使用该设备治疗产科出血；所有十名患者的出血均迅速停止，其中两名被送往医院。在加德满都，使用当地裁缝和物资在有限的生产环境下生产该设备，每个设备的成本约为40美元。
初步数据表明，一种廉价、易于制作的设备可能是资源有限地区当前产科出血治疗的合适补充，值得进一步研究。
