孕产妇弥散性血管内凝血的成分输血疗效观察

目的探讨成分输血抢救孕产妇弥散性血管内凝血(DIC)的疗效。方法参照DIC诊断标准、治疗原则及成分输血方案制订详细的孕产妇DIC治疗方案,分析在去除病因前、后输注成分血,特别是新鲜冰冻血浆(FFP)对血常规及出凝血相关指标的影响及临床出血情况。结果符合条件的25名病人在去除病因前,成分输血(如FFP)对临床出血症状、血小板计数、凝血酶原时间、活化的部分凝血活酶时间、纤维蛋白原、3P试验等指标的纠正不明显(P>0.10),但在病因去除后得到明显改善(P<0.001)。在输注浓缩血小板前静脉注射微量肝素10mg是比较安全的。羊水栓塞孕产妇在密切观察下及时静脉注射小剂量肝素(25～50mg)可阻止DIC的进展。结论成分输血抢救孕产妇DIC出血有一定疗效,在去除病因后疗效更好,早期输注成分血对去除产科病因,赢得抢救时间有积极作用。

Blood component transfusion in pregnants women and parturient complicated with disseminated intravascular coagulation

Objective To explore effectiveness of component transfusion in rescuing pregnant women and parturients with disseminated intravascular coagulation (DIC).Methods Establish a rescue group for emergency pregnant women and parturients, reference diagnostic criteria of DIC, treatment principles and components transfusion protocol, with detail plans. Clinical status, complete blood cell counts, coagulation tests were analyzed before and after components transfusion, especially fresh frozen plasma (FFP) transfusion.Results In 25 cases meeting with the diagnostic criteria of DIC, therapeutic effects of component transfusion on correcting some coagulation index abnormality e.g.platelet counts, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), plasma protamine paracoagulation (3P) test, and clinical bleeding manifestations were not significant before removing the causes of diseases( P >0.10), but more significant after the causes of DIC were corrected( P <0.001).Infusion of small dose heparin sodium (10mg) was safe before platelet transfusion. Infusion of small doses of heparin sodium (25~50mg) in patients with amniotic embolism under close observation could delay or stop DIC progress.Conclusion Blood component transfusion has some therapeutic effects in rescuing pregnant women and parturients with DIC, especially after the removal of the causes of DIC. Early component transfusions may play an active role in removing the causes and gaining rescue time.