Seto S, Itakura A, Okagaki R, Suzuki M, Ishihara O
Department of Obstetrics and Gynecology, Saitama Medical University, Japan.
Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Japan.
Int J Obstet Anesth. 2017 Nov;32:11-16. doi: 10.1016/j.ijoa.2017.03.005. Epub 2017 Apr 1.
We constructed an algorithm for the management of coagulopathy from massive postpartum hemorrhage. Fibrinogen concentrate was administered preferentially, and the dose of both fibrinogen concentrate and fresh frozen plasma given was determined by the plasma fibrinogen concentration and prothrombin time. The efficacy of the algorithm and the amount of fibrinogen concentrate and fresh frozen plasma transfused were determined.
The study was conducted in a single teaching perinatal center. Nineteen patients were included between April 2011 and March 2014 (patient group). For a historical comparison group, we retrospectively analyzed the records of 19 patients who had been treated for coagulopathy from massive postpartum hemorrhage between April 2006 and March 2011 (control group).
Blood loss was significantly lower in the patient group. No adverse events were associated with this management in either group. The dose of fibrinogen concentrate administered was significantly higher and that of fresh frozen plasma administered was significantly lower in the patient group.
This algorithm appeared to help reduce blood loss and the total amount of fresh frozen plasma transfused when treating coagulopathy from postpartum hemorrhage, and may represent another strategy for achieving hemostasis in this setting.
我们构建了一种用于管理产后大出血所致凝血功能障碍的算法。优先给予纤维蛋白原浓缩物，并根据血浆纤维蛋白原浓度和凝血酶原时间确定纤维蛋白原浓缩物和新鲜冰冻血浆的给药剂量。我们确定了该算法的疗效以及输注的纤维蛋白原浓缩物和新鲜冰冻血浆的量。
该研究在一家教学围产期中心进行。2011年4月至2014年3月期间纳入了19例患者（患者组）。为了进行历史对照，我们回顾性分析了2006年4月至2011年3月期间因产后大出血所致凝血功能障碍接受治疗的19例患者的记录（对照组）。
患者组的失血量显著更低。两组中该管理措施均未出现不良事件。患者组中给予的纤维蛋白原浓缩物剂量显著更高，而给予的新鲜冰冻血浆剂量显著更低。
该算法在治疗产后大出血所致凝血功能障碍时似乎有助于减少失血量和新鲜冰冻血浆的输注总量，并且可能代表了在此种情况下实现止血的另一种策略。
