Assistant Professor of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Missouri Women's and Children's Hospital, Columbia, MO.
Professor of Medicine, Pathology, and Pediatrics, Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, OR.
Obstet Gynecol Surv. 2018 Jul;73(7):418-422. doi: 10.1097/OGX.0000000000000582.
In women with postpartum hemorrhage, the need to transfuse a large amount of blood products is frequent. The ABCD of massive transfusions-Assessment/Activation, Blood products, Complications, and Drugs-can help manage this complex situation. There needs to be a defined method to activate the massive transfusion protocol and a well-defined means to assess the coagulation status of the patient by either traditional laboratory tests or point of care methods such as thromboelastography. Recent data supports more aggressive use of plasma in the massively transfused patient. Obstetricians need to be vigilant in assessing compilations, especially hypothermia. Given the increased use of antithrombotic drugs in bleeding patients, one needs to consider reversal of these agents. Finally, consideration of the role of other agents such as antifibrinolytic agents in the management of the bleeding patient is important. It is important for every hospital to have a well-defined massive transfusion protocol to streamline the care of postpartum hemorrhage.
在产后出血的女性中，频繁需要输注大量血液制品。大量输血的 ABCD（评估/激活、血液制品、并发症和药物）可以帮助管理这种复杂情况。需要有明确的方法来激活大量输血方案，并通过传统实验室检查或即时检测方法（如血栓弹力图）来明确评估患者的凝血状态。最近的数据支持在大量输血的患者中更积极地使用血浆。产科医生需要警惕并发症的发生，尤其是低体温。鉴于在出血患者中越来越多地使用抗血栓药物，需要考虑逆转这些药物的作用。最后，考虑在出血患者的管理中使用其他药物（如抗纤维蛋白溶解药物）的作用也很重要。对于每家医院来说，制定明确的大量输血方案以简化产后出血的护理都很重要。
