Massive Blood Transfusion During Hospitalization for Delivery in New York State, 1998-2007
Massive Blood Transfusion During Hospitalization for Delivery in New York State, 1998-2007
复制标题
DOI：
10.1097/aog.0000000000000021
复制
发表时间：
2013-12-01
影响因子：
7.2
通讯作者：
Bateman, Brian T.
中科院分区：
文献类型：
--
作者：
Mhyre, Jill M.;Shilkrut, Alexander;Bateman, Brian T.
目的：探讨产科大量输血的发生频率、危险因素和结局。方法：使用纽约州住院患者数据集（1998-2007）来确定每年报告至少一次分娩相关输血的医院的所有分娩住院情况。采用多变量logistic回归分析来检验母亲年龄、种族和相关临床变量与大量输血风险之间的关系，大量输血定义为10个或更多单位的血液记录。结果：每10000例分娩中有6例出现大量输血并发症，即使在最小的设施中也有病例发生。与大量输血独立相关性最强的危险因素包括胎盘异常（1.6/10,000分娩，调整比值比[OR] 18.5, 95%可信区间[CI] 14.7-23.3）、胎盘早剥（1.0/10,000，调整比值比[OR] 14.6, 95% CI 11.2-19.0）、严重先兆子痫（0.8/10,000，调整比值比[OR] 10.4, 95% CI 7.7-14.2）和宫内胎儿死亡（0.7/10,000，调整比值比[OR] 5.5, 95% CI 3.9-7.8）。大量输血最常见的原因是胎盘异常（26.6%）、子宫张力失调（21.2%）、胎盘早脱（16.7%）和产后出血合并凝血功能障碍（15.0%）。大量接受输血的妇女出现严重并发症的比例过高，包括肾衰竭、急性呼吸窘迫综合征、败血症和院内死亡。结论：无论设施规模大小，大量输血都不常见。在已知存在接受大量输血风险的情况下，应告知妇女这种可能性，如果可能，应在资源充足的设施中分娩，并应在分娩前接受适当的血液制品制备和静脉通路。
OBJECTIVE: To define the frequency, risk factors, and outcomes of massive transfusion in obstetrics.METHODS: The State Inpatient Dataset for New York (1998-2007) was used to identify all delivery hospitalizations for hospitals that reported at least one delivery-related transfusion per year. Multivariable logistic regression analysis was performed to examine the relationship between maternal age, race, and relevant clinical variables and the risk of massive blood transfusion defined as 10 or more units of blood recorded.RESULTS: Massive blood transfusion complicated 6 of every 10,000 deliveries with cases observed even in the smallest facilities. Risk factors with the strongest independent associations with massive blood transfusion included abnormal placentation (1.6/10,000 deliveries, adjusted odds ratio [OR] 18.5, 95% confidence interval [CI] 14.7-23.3), placental abruption (1.0/10,000, adjusted OR 14.6, 95% CI 11.2-19.0), severe preeclampsia (0.8/10,000, adjusted OR 10.4, 95% CI 7.7-14.2), and intrauterine fetal demise (0.7/10,000, adjusted OR 5.5, 95% CI 3.9-7.8). The most common etiologies of massive blood transfusion were abnormal placentation (26.6% of cases), uterine atony (21.2%), placental abruption (16.7%), and postpartum hemorrhage associated with coagulopathy (15.0%). A disproportionate number of women who received a massive blood transfusion experienced severe morbidity including renal failure, acute respiratory distress syndrome, sepsis, and in-hospital death.CONCLUSION: Massive blood transfusion was infrequent, regardless of facility size. In the presence of known risk for receipt of massive blood transfusion, women should be informed of this possibility, should deliver in a well-resourced facility if possible, and should receive appropriate blood product preparation and venous access in advance of delivery.