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目的探讨重型胎盘早剥合并弥漫性血管内凝血(DIC)的输血策略。方法回顾性分析宁波市妇女儿童医院2003年1月至2010年12月30例在终止妊娠和产科止血的基础上采用了限制性成分输血治疗的重型胎盘早剥合并DIC患者的临床资料,记录产后出血量、输血的种类及数量、止血时间、妊娠结局,治疗前后血液学指标变化。结果 30例患者均抢救成功,28例保全子宫,凝血功能逐渐好转,出血逐渐停止,止血时间中位数3.45(3～7)h,无明显并发症。输注红细胞前平均血红蛋白质量浓度(Hb)(75.36±7.39)g/L,输注红细胞24h后平均Hb(97.30±6.26)g/L,两者差异有统计学意义(P<0.01),97%的输血前Hb质量浓度和95%的输血后Hb质量浓度符合推荐标准。结论限制性成分输血可有效利用血液,改善凝血功能,帮助止血,是重型胎盘早剥合并DIC救治成功的关键措施。
Objective To investigate the transfusion strategy of severe placental abruption combined with diffuse intravascular coagulation (DIC). Methods A retrospective analysis of Ningbo Women and Children Hospital from January 2003 to December 2010 30 cases of termination of pregnancy and obstetric hemostasis based on the use of restrictive components of transfusion of blood in patients with severe placental abruption combined DIC clinical data records postpartum Blood loss, the type and quantity of blood transfusion, bleeding time, pregnancy outcome, hematological changes before and after treatment. Results All the 30 patients were successfully rescued. 28 cases preserved the uterus, the coagulation function gradually improved, the bleeding stopped gradually, and the median time of hemostasis was 3.45 (3-7) h with no obvious complication. The average hemoglobin concentration (Hb) was (75.36 ± 7.39) g / L before transfused erythrocytes and mean Hb (97.30 ± 6.26) g / L after transfused erythrocytes for 24 hours, the difference was statistically significant (P <0.01) The pre-transfusion Hb concentration of 95% and the post-transfusion Hb mass concentration complied with the recommended standards. Conclusion Restrictive components of blood transfusion can effectively use the blood, improve blood coagulation, help to stop bleeding, and it is the key measure for the successful treatment of severe placental abruption combined with DIC.