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摘要:
目的 分析产科围产期输血的相关因素, 以指导临床减少围产期出血。 方法 回顾性分析2013年1月至2014年12月于北京协和医院分娩并输血的80例产妇的临床资料, 分析产科输血的主要疾病类型, 计算其输血率及输血量, 筛选围产期输血的主要危险因素。 结果 输血产妇平均年龄(29.8±4.8)岁, 平均分娩孕周为(35.6±4.3)周。总用血量503 U, 其中红细胞悬液293 U, 血浆151 U, 血小板59 U。输血率超过20%的疾病依次为:HELLP综合征(61.1%)、凶险性前置胎盘(57.1%)、胎盘植入(57.1%)、妊娠期急性脂肪肝(57.1%)、胎盘早剥(50.0%)、血液病(41.2%)、宫缩乏力(40.7%)和重度子痫前期(24.2%)。平均输血量超过8 U的疾病依次为:急产(15.0 U)、凶险性前置胎盘(14.0 U)、胎盘植入(13.7 U)、胎盘早剥(13.2 U)和急性脂肪肝(9.6 U)。 结论 多种妊娠合并症和并发症可诱发严重的产后出血, 甚至发生常规手段难以控制的难治性产后出血。对高危产妇进行规范诊治、采取预防性措施、及时发现出血、提高止血技巧, 是减少产后出血量, 节约血制品, 并最终取得出血抢救成功的关键。 Abstract:Objective To analyze the clinical factors related to perinatal blood transfusion, thus to assist clinicians in reducing perinatal hemorrhage. Methods We retrospectively analyzed clinical records of 80 parturients who delivered and received perinatal transfusion at Peking Union Medical College Hospital in the period from January 2013 to December 2014, focusing on the correlation of blood transfusion with major pregnancy complications, calculating the rate and volume of blood transfusion, to elucidate the major risk factors contributing to postpartum hemorrhage and perinatal transfusion. Results The mean age of parturients receiving blood transfusion was (29.8±4.8) years, and the mean gestational weeks at delivery was (35.6±4.3) weeks. The total blood transfusion volume was 503 U, including 293 U red blood cell suspension, 151 U plasma, and 59 U platelet. The blood transfusion rate was over 20% in the following conditions:HELLP syndrome (61.1%), pernicious placenta previa (57.1%), placenta accrete (57.1%), pregnancy acute fatty liver (57.1%), placental abruption (50.0%), hematologic diseases (41.2%), uterine inertia (40.7%) and severe preeclampsia (24.2%). The average blood transfusion volume was over 8 U in precipitate labor (15.0 U), pernicious placenta previa(14.0 U), placenta accrete (13.7 U), placental abruption (13.2 U), and acute fatty liver (9.6 U). Conclusions Various pregnancy comorbidities and complications can lead to severe postpartum hemorrhage, even hemorrhage refractory to conventional measurements. Standard diagnosis and treatment of high-risk parturients, preventive procedure, timely detection of hemorrhage, and improved skills to control bleeding are the key to reducing postpartum hemorrhage, saving blood products, and to successful rescue in these emergencies. -
Key words:
- perinatal /
- blood transfusion /
- pregnancy comorbidity /
- postpartum hemorrhage
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表 1 产科主要并发症和合并症的输血情况
疾病种类 输血率(输血例数/
总病例数)总输血量
(U)输血者平均输血量
(x±s, U)HELLP综合征 61.1%(11/18) 65 5.9±6.7 凶险性前置胎盘 57.1%(4/7) 56 14.0±12.7 胎盘植入 57.1%(8/14) 93 13.7±11.6 急性脂肪肝 57.1%(8/14) 75 9.6±14.4 胎盘早剥 50.0%(7/14) 93 13.2±9.0 血液病 41.2%(17/41) 48 2.8±1.3 宫缩乏力 40.7%(11/27) 73 6.6±5.7 重度子痫前期 24.2%(16/66) 100 6.3±6.5 前置胎盘 15.4%(10/65) 77 7.7±8.8 系统性红斑狼疮 9.1%(4/44) 7 1.8±0.5 双胎 7.6%(6/79) 22 3.7±2.0 前次剖宫产史 5.7%(11/193) 65 5.9±8.9 急产 1.9%(2/106) 30 15.0±9.8 妊娠期糖尿病 1.5%(8/544) 28 3.8±2.5 巨大儿 1.0%(2/195) 8 4.0±2.8 
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