产科出血。

Obstetrical Hemorrhage.

机构信息

Obstetric Anesthesiology, UPMC Magee Women's Hospital, University of Pittsburgh Medical School, 300 Halket Street, Pittsburgh, PA 15213, USA.

Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital, Patient Blood Management Program, 300 Halket Street, Pittsburgh, PA 15213, USA.

出版信息

Anesthesiol Clin. 2021 Dec;39(4):597-611. doi: 10.1016/j.anclin.2021.08.009.

DOI:10.1016/j.anclin.2021.08.009

PMID:34776099

Abstract

Obstetric hemorrhage is a leading cause of morbidity and mortality. Prevention includes identifying patients with risk factors and actively managing the third stage of labor. The anesthesiologist should be ready to manage hemorrhage with general strategies as well as strategies tailored to the specific cause of hemorrhage. Both neuraxial anesthesia and general anesthesia are appropriate in different situations. Treatments proven to be effective include increasing the oxytocin infusion, administering tranexamic acid early, guiding transfusion with point-of-care tests, and using cell salvage. Utilization of protocols and checklists within systems that encourage effective communication between teams should be implemented.

摘要

产科出血是导致发病率和死亡率的主要原因。预防包括识别具有危险因素的患者，并积极管理第三产程。麻醉师应准备好通过一般策略以及针对出血具体原因的策略来管理出血。在不同情况下，椎管内麻醉和全身麻醉都是合适的。已证明有效的治疗方法包括增加催产素输注、早期给予氨甲环酸、使用即时检测指导输血以及使用细胞回收。应在鼓励团队之间有效沟通的系统中实施协议和检查表的使用。