Park Soon Chang, Yeom Seok Ran, Han Sang Kyoon, Jo Young Mo, Kim Hyung Bin
Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea.
Department of Emergency Medicine, Pusan National University School of Medicine, Yangsan, Korea.
Korean J Crit Care Med. 2017 Nov;32(4):333-339. doi: 10.4266/kjccm.2016.00787. Epub 2017 Nov 30.
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients' mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.
几十年来，严重或大量产后出血（PPH）一直是全球孕产妇死亡的主要原因，并导致严重的产科并发症。重组活化因子VII（rFVIIa）已成为治疗常规疗法难治的危及生命的PPH的金标准辅助止血剂，尽管其在PPH治疗中仍未获得许可使用。我们研究了rFVIIa对韩国PPH患者凝血功能障碍、输血量、预后及严重程度变化的影响。
对2008年12月至2011年3月期间使用rFVIIa治疗严重PPH的病历进行回顾性研究。我们比较了急诊入院时及24小时后SOFA评分≥8分患者的年龄、rFVIIa治疗情况、输血量及序贯器官衰竭评估（SOFA）评分。
15名SOFA评分≥8分的女性参与了本研究，其中8名接受了rFVIIa治疗，7名未接受。患者平均年龄为31.7±7.5岁。接受rFVIIa治疗和未接受治疗的患者初始及24小时后的SOFA评分无统计学显著差异。rFVIIa治疗后，初始就诊至24小时后SOFA评分的变化显著降低（P = 0.016）。
本分析旨在支持rFVIIa给药可降低患者危及生命的PPH严重程度。对于没有有效标准治疗方法的严重PPH患者，需要迅速决定是否给予rFVIIa以获得更有利的结果。
