血栓弹力图指导的产后出血治疗：一项随机对照试验

以下文章来源于罂粟花 ，作者anesthGH

本文由“罂粟花”授权转载

血栓弹力图指导的产后出血治疗：一项随机对照试验  

贵州医科大  麻醉与心脏电生理课题组

翻译：柏雪

编辑：柏雪

审校：曹莹

背景：

产后出血导致产妇死亡率很高。基于临床判断和常规凝血试验的结果采用早期输血液制品已适应于产后出血的治疗，但血栓弹力图 (ROTEM) 可动态监测整个凝血过程从而为临床医生提供目标导向治疗。我们进行了一项平行设计、随机、对照试验来比较这两种方法。我们假设ROTEM指导的方案会减少对红细胞输注的需求。

方法：

我们将60名产后出血超过1500毫升的产妇随机分配接受ROTEM指导或常规治疗，最终54名患者纳入分析。主要结果是血液制品的消耗，其次我们评估了控制失血可能产生的副作用，例如血栓栓塞并发症、感染和输血反应。

结果：

ROTEM组输注红细胞单位的中位数（第 25-75 个百分位数）为2 (1-4)，对照组为 3 (2-4)（P= 0.399）。两组中给予的 OctaplasLG®单位（主要成分人血浆蛋白）的中位数均为0（0–0 和 0–2）（P =0.030）。ROTEM组的总估计失血量中位数为2500毫升（2100-3000），对照组为3000毫升（2200-3100）（P= 0.033）。次要结局未观察到差异。  

结论：

ROTEM指导的产后出血治疗可能具有血浆保护作用，但可能仅略微减少总失血量。

原始文献来源：

Samuli Jokinen, Anne Kuitunen, Jukka Uotila and Arvi Yli-Hankala. Thromboelastometry-guided treatment algorithm in postpartum haemorrhage: a randomised, controlled pilot trial. British Journal of Anaesthesia, 130 (2): 165-174 (2023)        

英文原文：

Thromboelastometry-guided treatment algorithm in postpartum haemorrhage: a randomised, controlled pilot trial

Abstract

Background: Postpartum haemorrhage causes significant mortality among parturients. Early transfusion of blood products based on clinical judgement and conventional coagulation testing has been adapted to the treatment of postpartum haemorrhage, but rotational thromboelastometry (ROTEM) may provide clinicians means for a goal-directed therapy to control coagulation. We conducted a parallel design, randomised, controlled trial comparing these two approaches. We hypothesised that a ROTEM-guided protocol would decrease the need for red blood cell transfusion. Methods: We randomised 60 parturients with postpartum haemorrhage of more than 1500 ml to receive either ROTEMguided or conventional treatment, with 54 patients included in the final analysis. The primary outcome was consumption of blood products, and secondarily we assessed for possible side-effects of managing blood loss such as thromboembolic complications, infections, and transfusion reactions.   

Results: The median (25th-75th percentile) number of RBC units transfused was 2 (1-4) in the ROTEM group and 3 (2-4) in the control group (P=0.399). The median number of OctaplasLG® units given was 0 in both groups (0-0 and 0-2) (P=0.030). The median total estimated blood loss was 2500 ml (2100-3000) in the ROTEM group and 3000 ml (2200-3100) in the control group (P=0.033). No differences were observed in secondary outcomes.  

Conclusions: ROTEM-guided treatment of postpartum haemorrhage could have a plasma-sparing effect but possibly only a small reduction in total blood loss.  

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校对：Michel.米萱