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中华产科急救电子杂志 ›› 2025, Vol. 14 ›› Issue (02) : 75 -79. doi: 10.3877/cma.j.issn.2095-3259.2025.02.003

降低产科出血改善不良妊娠结局

严重产后出血容量复苏
付以琳1, 丁文成1,()   
  1. 1. 430030 武汉,华中科技大学同济医学院附属同济医院产科,国家妇产疾病临床医学研究中心
  • 收稿日期:2024-10-23 出版日期:2025-05-18
  • 通信作者: 丁文成
  • 基金资助:
    国家重点研发计划(2021YFC2701500)

Volume resuscitation of severe postpartum hemorrhage

Yilin Fu, Wencheng Ding()   

  • Received:2024-10-23 Published:2025-05-18
  • Corresponding author: Wencheng Ding
引用本文:

付以琳, 丁文成. 严重产后出血容量复苏[J/OL]. 中华产科急救电子杂志, 2025, 14(02): 75-79.

Yilin Fu, Wencheng Ding. Volume resuscitation of severe postpartum hemorrhage[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2025, 14(02): 75-79.

产后出血是导致我国孕产妇死亡的主要原因,早期诊断并及时启动休克复苏治疗是恢复产妇循环血容量、避免产妇死亡的关键。由于妊娠期循环血容量的生理性改变使得严重产后出血的休克体征不再典型,临床易于忽视,从而丧失最佳抢救时机。容量复苏是维持产妇血流动力学稳定的关键,包括积极复苏和限制性液体复苏(临床宜选择限制性液体复苏),并在复苏的同时积极明确产后出血的病因、准备输血或成分输血,在容量复苏基础上尽快输血治疗以补充红细胞、凝血因子等,以达到复苏效果最大化并减少副作用。本文从产后出血的病理生理特征、早期处理、容量复苏方案、复苏液体的种类和选择以及复苏并发症等方面对产后出血的容量复苏进行论述,旨在为产后出血的早期诊断和抢救提供更多依据,以降低孕产妇死亡风险。

Postpartum hemorrhage is a leading cause of maternal death in China.Early diagnosis and prompt initiation of shock resuscitation are key to restoring the maternal circulating blood volume and avoiding maternal mortality.Due to the physiological changes in circulating blood volume during pregnancy,the signs of shock in severe postpartum hemorrhage are no longer typical,which can easily be overlooked clinically,thus losing the best opportunity for rescue.Volume resuscitation is essential for maintaining maternal hemodynamic stability, including active resuscitation and restrictive fluid resuscitation.Clinically,restrictive fluid resuscitation should be chosen while actively clarifying the etiology of postpartum hemorrhage and preparing for blood or component transfusion.Transfusion should be initiated promptly following volume resuscitation to supplement red blood cells,coagulation factors,etc.,maximizing the resuscitation efficacy and minimizing side effects.This article discusses the volume resuscitation of postpartum hemorrhage from the following aspects:pathophysiological characteristics of postpartum hemorrhage,early treatment,volume resuscitation plans,types and selection of resuscitation fluids,and complications of resuscitation,aiming to provide more basis for the early diagnosis and rescue of postpartum hemorrhage,thereby reducing the risk of maternal death.

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