摘要
目的:探究产后出血患者液体复苏中液体用量与弥散性血管内凝血(DIC)发生风险的关系.方法:选择2016 年1 月1 日至2022 年12 月31 日沈阳市妇婴医院收治的产后出血量≥1000 ml的患者进行回顾性病例对照研究.根据妊娠校正国际血栓与止血协会(ISTH)评分将患者分为两组:ISTH评分＞26 分组、ISTH评分≤26 分组,两组样本进行1 ∶ 4 倾向性评分匹配,比较两组输入晶体液与出血量比值、胶体液与出血量比值、输注红细胞量与出血量比值、输注血浆量与出血量比值及纤维蛋白原下降峰值之间差异,并对各项观察指标与发生DIC关系进行分析.结果:晶体液与出血量比值、胶体液与出血量比值、纤维蛋白原下降峰值、输注红细胞量与出血量比值、输注血浆量与出血量比值预测产后出血患者发生DIC 的ROC 曲线下面积(AUC)分别为 0.670(95%CI 0.589～0.751)、0.532(95%CI 0.440～0.623)、0.771(95%CI 0.706～0.837)、0.530(95%CI 0.439～0.621)、0.563(95%CI 0.473～0.653),最佳界值分别为1.23、0.29、0.77、0.48、0.24.晶体液与出血量比值、纤维蛋白原下降峰值与产后出血患者DIC的发生有关,OR分别为0.256(95%CI 0.111～0.590)、0.074(95%CI 0.024～0.228).胶体液与出血量比值、输注红细胞量与出血量比值、输注血浆量与出血量比值与产后出血患者DIC的发生无相关性.结论:晶体液输注量与DIC的发生有关,限制性的液体复苏可以降低DIC的发生率.同时发现当纤维蛋白原下降超过 0.77 g/L时,增加产后出血患者DIC的发生风险,应该及时补充纤维蛋白原或冷沉淀以降低DIC发生.
Abstract
Objective:To explore the relationship between fluid dosage during fluid resuscitation and the risk of disseminated intravascular coagulation(DIC)in postpartum hemorrhage patients.Methods:A retrospective case-control study was conducted on patients who were admitted to Shenyang Women′s and Children′s Hospital between January 1,2016,and December 31,2022 with postpartum hemorrhage≥1000 ml.The patients were di-vided into two groups according to pregnancy-corrected ISTH scores:group with ISTH score＞26;group with ISTH score≤26.The two groups were matched for 1 ∶ 4 propensity scores and the differences between ratio of crystalloid solution to bleeding volume;ratio of colloidal solution to bleeding volume;ratio of red blood cell infusion to bleeding volume;ratio of plasma infusion to bleeding volume and peak decrease of fibrinogen in the two groups were compared.And analyze the relationship between various observation indicators and the occurrence of DIC.Results:The ROC area under the curve(AUC)values for predicting of the ratio of crystalloid solution to bleeding volume,ratio of colloidal solution to bleeding volume,the peak decrease in fibrinogen,ratio of red blood cell infu-sion to bleeding volume,ratio of plasma infusion to bleeding volume were 0.670(95%CI 0.589-0.751),0.532(95%CI 0.440-0.623),0.771(95%CI 0.706-0.837),0.530(95%CI 0.439-0.621),and 0.563(95%CI 0.473-0.653),the optimal cut off values were 1.23,0.29,0.77,0.48,0.24.The ratio of crystalloid solution to bleeding volume and the peak decrease in fibrinogen were positively correlated with the occurrence of DIC after postpartum hemorrhage,the OR values were 0.256(95%CI 0.111-0.590)and 0.074(95%CI 0.024-0.228).There was no correlation between the ratio of colloidal solution to bleeding volume,the ratio of red blood cell infusion to bleeding volume,the ratio of plasma infusion to bleeding volume and the occurrence of DIC after postpartum hemorrhage.Conclusions:The infusion volume of crystalloid solution is related to the occurrence of DIC,and restrictive fluid resuscitation can reduce the incidence of DIC.Additionally,to lower the risk of DIC,fibrin-ogen or cold precipitation should be rapidly supplied when the decrease of fibrinogen exceeded 0.77 g/L to re-duce the risk of postpartum hemorrhage DIC.
基金项目
沈阳市中青年科技创新人才支持计划项目(RC210043)
维普
万方数据