Weiniger C F, Yakirevich-Amir N, Sela H Y, Gural A, Ioscovich A, Einav S
Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center and Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Medical School, The Hebrew University of Jerusalem, Israel.
Int J Obstet Anesth. 2018 Nov;36:34-41. doi: 10.1016/j.ijoa.2018.08.001. Epub 2018 Aug 17.
Administration of packed red blood cells (PRBC) and fresh frozen plasma (FFP) to women with postpartum hemorrhage (PPH) before and after introduction of a massive transfusion protocol.
The retrospective PPH study cohort of two tertiary centers was identified using blood bank records, verified by patient electronic medical records. We identified women transfused with ≥3 units PRBC in a short time period within 24 hours of delivery. Since 2010, both centers have used a protocol using 1:1 FFP:PRBC ratios. Demographic, obstetric, and blood management data were retrieved from medical records. Outcome measures included estimated blood loss, blood product administration, and hematologic variables.
273 women were included, 112 (41.0%) prior to introduction of the protocol (2004-2009) and 161 (59.0%) afterwards (2010-2014). The frequency of women managed with 1:1 FFP:PRBC ratios was similar before 55/112 (49.1%) and after 83/161 (51.6%) introduction of the protocol (P=0.69). There was strong correlation between PRBC units transfused and the FFP:PRBC transfusion ratio (R-square 0.866, P <0.0001), demonstrating that as the number of transfused PRBC units increased, FFP:PRBC ratios became closer to 1:1. There were no outcome differences between women managed before and after introduction of the protocol.
Among women with PPH receiving ≥3 PRBC units within a short period of time, it appears that factors other than the existence of our massive transfusion protocol influence the number and ratio of PRBC and FFP units transfused. Blood products were not transfused according to exact ratios, even when guided by a protocol.
在实施大量输血方案前后，对产后出血（PPH）妇女输注浓缩红细胞（PRBC）和新鲜冰冻血浆（FFP）。
利用血库记录确定两个三级中心的回顾性PPH研究队列，并通过患者电子病历进行核实。我们确定了在分娩后24小时内短时间内输注≥3单位PRBC的妇女。自2010年以来，两个中心都采用了FFP:PRBC比例为1:1的方案。从病历中检索人口统计学、产科和血液管理数据。结局指标包括估计失血量、血液制品输注情况和血液学变量。
共纳入273名妇女，其中112名（41.0%）在方案实施前（2004 - 2009年），161名（59.0%）在方案实施后（2010 - 2014年）。在方案实施前，55/112（49.1%）的妇女采用1:1的FFP:PRBC比例进行治疗，方案实施后这一比例为83/161（51.6%），两者相似（P = 0.69）。输注的PRBC单位数与FFP:PRBC输血比例之间存在强相关性（决定系数0.866，P < 0.0001），表明随着输注的PRBC单位数增加，FFP:PRBC比例更接近1:1。方案实施前后接受治疗的妇女在结局方面没有差异。
在短时间内接受≥3单位PRBC的PPH妇女中，似乎除了我们的大量输血方案外，其他因素也会影响PRBC和FFP单位的输注数量和比例。即使在方案指导下，血液制品也未按照精确比例输注。
