Ismail S, Siddiqui S, Shafiq F, Ishaq M, Khan S
Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
Department of Anaesthesia, SICU and Pain Management, Dow Medical College and Civil Hospital, Karachi, Pakistan.
Int J Obstet Anesth. 2014 Aug;23(3):253-9. doi: 10.1016/j.ijoa.2014.01.004. Epub 2014 Feb 4.
Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan.
In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin.
A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (P<0.05). More emergency caesarean sections were performed in the public compared to the private hospitals (85.4% vs. 41.6%). More multiparous patients underwent caesarean section in the public hospital (57.8% vs. 40.4%). Attending physicians took the decision for transfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals.
Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required.
对输血风险的认识不断提高，促使人们对产科红细胞输血实践进行审视。在巴基斯坦的三家医院开展了一项为期六个月的前瞻性观察研究，以检查剖宫产患者的输血实践情况。
在研究期间，这三家医院（两家私立，一家公立）共进行了3438例剖宫产手术。收集了患者人口统计学数据、输血指征、开医嘱的医生、同意情况、与产科因素的关联、估计允许失血量、计算失血量、输血前后血红蛋白及出院时血红蛋白等数据。
共有397例（11.5%）接受剖宫产手术的患者接受了输血。公立三级护理医院的输血率最高，为16%，而两家私立医院为5%。急诊剖宫产和经产与输血相关（P<0.05）。与私立医院相比，公立医院进行的急诊剖宫产更多（85.4%对41.6%）。公立医院经产妇接受剖宫产手术的更多（57.8%对40.4%）。98%的病例中，输血决定由主治医生做出。在343例（86%）患者中，即使血红蛋白>7g/dL也进行了输血。在这三家医院中，均未发现记录输血指征或同意情况的方法。
公立医院更易开出输血医嘱。需要确定输血触发因素并制定机构指南以减少不必要的输血。
