Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK.
Anaesthesia. 2015 Jan;70 Suppl 1:78-86, e27-8. doi: 10.1111/anae.12913.
The haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non-pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point-of-care monitoring of coagulation abnormalities, and the potential to give goal-directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause. This review examines areas such as possible intervention points, describes evidence for over-transfusion of fresh frozen plasma in some situations and challenges conventional thinking on formulaic management. It also examines the rationale for other therapeutic options, including fibrinogen concentrate and tranexamic acid.
产后大出血的止血处理仍然颇具挑战性，目前已发表的指南主要依赖于非妊娠人群的经验和专家意见。近年来，人们对相对低纤维蛋白原血症的影响、即时凝血功能监测以及纠正凝血障碍的靶向治疗的可能性产生了浓厚的兴趣，这为指南的重大挑战和改变创造了条件。有证据表明，妊娠人群的止血功能障碍与创伤引起的出血不同，并且根据潜在病因，凝血障碍的类型和发病速度也有所不同。本文综述了可能的干预点，描述了在某些情况下过度输注新鲜冰冻血浆的证据，并对常规公式化处理方法提出了挑战。还探讨了其他治疗选择的原理，包括纤维蛋白原浓缩物和氨甲环酸。
