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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (05) : 497 -503. doi: 10.3877/cma.j.issn.1673-5250.2020.05.001

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产科患者血液管理
周凡1, 李雅倩1, 邓茜茜1, 王晓东1,†()   
  1. 1. 四川大学华西第二医院妇产科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
  • 收稿日期:2020-05-02 修回日期:2020-08-31 出版日期:2020-10-01
  • 通信作者: 王晓东

Patient blood management in obstetrics

Fan Zhou1, Yaqian Li1, Xixi Deng1, Xiaodong Wang1,†()   

  1. 1. Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2020-05-02 Revised:2020-08-31 Published:2020-10-01
  • Corresponding author: Xiaodong Wang
  • Supported by:
    Key Research Project of Science and Technology Plan in Sichuan Province(2018SZ0265)
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周凡, 李雅倩, 邓茜茜, 王晓东. 产科患者血液管理[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(05): 497-503.

Fan Zhou, Yaqian Li, Xixi Deng, Xiaodong Wang. Patient blood management in obstetrics[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(05): 497-503.

妊娠期母体各组织系统发生的特殊生理变化，尤其是循环、血液系统和代谢方面，呈现高血容量、高动力和高氧耗特点。血容量增加和体液潴留，可以提高孕产妇对产科出血的代偿能力，但是孕期贫血、急性大量出血和组织代谢氧耗增高，则限制了孕产妇对失血的代偿。产科出血仍然是导致孕产妇死亡的主要原因，产科高效、合理的患者血液管理(PBM)，是改善孕产妇产科出血结局的关键。产科临床的PBM，是以患者为中心，参照循证医学证据，保证患者自身血容量、减少失血和优化患者对贫血耐受能力的个体化管理方案。产科PBM需要多学科合作，在孕期、产时和产后均针对PBM的3大要素进行管理。PBM的3大要素为：①采取一切合理措施，优化患者自身血容量和红细胞总量；②将患者失血量降至最低；③优化和利用患者对贫血的生理耐受能力。笔者拟结合产科临床实践，围绕《患者血液管理、止血和血栓进展网络(NATA)共识声明：产科患者血液管理》涉及的PBM要素，包括产科PBM涉及的相关妊娠生理、对妊娠合并贫血孕产妇的PBM、产科出血与限制性输血、对产后贫血患者的PBM、对RhD阴性患者输血的PBM、产科输血风险6个方面进行阐述。

关键词: 患者血液管理, 妊娠期贫血, 自身耐受性, 产后出血, 输血, 自体, 孕产妇

Pregnancy induces significantly physiological changes in multiple organs and systems, especially in circulatory, hematologic and metabolic systems. They are characterized by hypervolemia, hyperdynamic circulation and high oxygen consumption. The increase of total blood volume and fluid retention could improve compensatory adaptation to obstetric hemorrhage of pregnant women. However, anemia in pregnancy, acute massive bleeding and high consumption of oxygen in tissue metabolism limit this compensatory adaptation to hemorrhage during pregnancy. Obstetric hemorrhage is still one of the major causes of maternal mortality. Efficient and reasonable patient blood management (PBM) in obstetrics is key to improve pregnancy outcomes of obstetric hemorrhage. PBM in obstetrics applies evidence-based medical concepts to maintain patient′s own blood volume, minimise blood loss, and optimise patient′s physiological tolerance to anemia. PBM in obstetrics needs a multidisciplinary team. Pregnant women should be managed with the three key elements of PBM during antenatal, intrapartum and postpartum period. ① Making every reasonable endeavour to optimise the patient′s own blood volume and red blood cell mass. ② Minimising patient′s blood loss. ③ Optimising and utilizing the patient′s physiological tolerance of anemia. In this article, with the combination of clinical practice of obstetrics in China, we intend to interpret and discuss key issues related to PBM in obstetrics in Patient Blood Management in Obstetrics: Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) Consensus Statement from the aspects of PBM related physiology of pregnancy, PBM of anemia in pregnancy, obstetric hemorrhage and restrictive transfusion strategies, PBM in postpartum anemia, PBM of blood transfusion in RhD negative patients, and the risk of blood transfusion in obstetrics.

Key words: Patient blood management, Anemia in pregnancy, Self tolerance, Postpartum hemorrhage, Blood transfusion, autologous, Pregnant woman and puerperant
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