Center for Maternal, Foetal and Neonatal Medicine, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan.
Department of Transfusion Medicine and Cell Therapy, Saitama Medical Centre, Saitama Medical University, Kawagoe, Japan.
Sci Rep. 2017 Apr 24;7:46749. doi: 10.1038/srep46749.
Massive obstetric haemorrhage remains a major cause of maternal death attributable to hypofibrinogenaemia. Transfusion of large volumes of fresh frozen plasma (FFP) is required to normalise fibrinogen levels. We compared the efficacy of FFP (F group) with that of FFP plus fibrinogen concentrate (F + F group) in massive obstetric haemorrhage. In this retrospective study, we compared the medical charts (2004-2016) of 137 patients with <150 mg/dl fibrinogen treated with F + F (n = 47; after August 2009) or F (n = 56; before August 2009). Although fibrinogen concentrate was only administered in severe cases, the FFP/red blood cell concentrate (RCC) ratio was significantly lower in the F + F group than in the F group. A sub-group analysis of cases requiring ≥18 RCC units showed that the F + F group received significantly less FFP than the F group (40.2 ± 19.6 versus 53.4 ± 18.5 units; P = 0.047) and showed significantly less pulmonary oedema (24.0% vs 57.1%; P < 0.05) in the absence of any significant differences in pre-transfusion coagulation, estimated blood loss, or RCC transfusion volume. Administration of fibrinogen concentrate increased the rate of fibrinogen supplementation five-fold and reduced FFP dosage, the FFP/RCC ratio, and the incidence of pulmonary oedema.
大量产科出血仍然是导致低纤维蛋白原血症产妇死亡的主要原因。需要输注大量新鲜冷冻血浆（FFP）以使纤维蛋白原水平正常化。我们比较了 FFP（F 组）与 FFP 加纤维蛋白原浓缩物（F + F 组）在大量产科出血中的疗效。在这项回顾性研究中，我们比较了 137 名纤维蛋白原<150mg/dl 的患者的病历（2004-2016 年），这些患者接受了 F + F（n = 47；2009 年 8 月后）或 F（n = 56；2009 年 8 月前）治疗。尽管纤维蛋白原浓缩物仅在严重情况下使用，但 F + F 组的 FFP/红细胞浓缩物（RCC）比值明显低于 F 组。对于需要≥18 个 RCC 单位的病例进行的亚组分析表明，F + F 组接受的 FFP 明显少于 F 组（40.2 ± 19.6 与 53.4 ± 18.5 单位；P = 0.047），并且在没有任何显著差异的情况下，F + F 组的肺水肿发生率明显较低（24.0% vs 57.1%；P < 0.05），而在输血前凝血、估计失血量或 RCC 输血量方面没有显著差异。纤维蛋白原浓缩物的给药使纤维蛋白原补充的速度增加了五倍，并减少了 FFP 剂量、FFP/RCC 比值和肺水肿的发生率。
