Blood Transfusion in the War of 1939-45
Blood Transfusion in the War of 1939-45
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1939-45 年战争中的输血
DOI：
10.1136/bmj.2.4520.309-b
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发表时间：
1947
影响因子：
--
通讯作者：
R. Binning
中科院分区：
文献类型：
--
作者：
R. Binning
静脉注射麦角新碱治疗胎盘滞留 SIR，“胎盘去除”在“有任何问题吗？”中得到了完整且有用的答案。专栏（8 月 2 日，第 195 页）。然而，我可以评论一下使用静脉注射麦角新碱进行胎盘排出吗？当第一次分离这种物质时，进行了仔细的实验以确定最佳剂量。结果发现剂量为0.25毫克。或更多的静脉注射会在几分钟内产生不良副作用。因此 0.125 毫克。推荐的剂量似乎足以达到治疗目的。然而，随后的经验表明，在紧急情况下服用 0.25 毫克不会造成严重的不良影响。被给出。现在这个剂量似乎已经被广泛接受。事实上，正是通过这种剂量和这种途径，麦角新碱才能最有效地给药。然而，按照答案中的建议，将已经很大的剂量加倍，给予 0.5 毫克，似乎没有必要；它肯定会导致副作用，例如头晕、体重感和四肢无力，甚至可能呕吐。 0.5 毫克。应预留肌肉注射剂量。关于胎盘滞留的注射，规定：“但是，如果胎盘没有立即脱落，则必须立即进行手动取出。”旁边还写着：“即使出现沙漏型宫缩，只要控制了出血，也可以从容应对。”在这些相互矛盾的陈述中，我认为应该接受第二个，因为从紧密收缩的子宫中强行去除胎盘显然没有任何好处。麦角新碱的主要好处在于它能够将松弛的子宫转变为收缩的子宫。随着这一变化，产后出血（假设出血来自子宫本身）被阻止。因此，产科医生有机会关注患者的一般状况，必要时进行输血，如果胎盘没有脱落，则为随后进行手动取出手术所需的麻醉剂做准备。如果 Crede 挤奶要成功，就必须在眼底变硬、身体下半部分收缩到胎盘前之前进行。如果排精失败，则应等待一个小时，此后子宫很可能会每隔一段时间放松一次；这样胎盘的提取就变得相对简单和安全。
Intravenous Ergometrine for Retained Placenta SIR,-" Removal of Placenta" receives a full and useful answer in the" Any Questions?" column (Aug. 2, p. 195). May I, however, comment on the use of intravenous ergometrine for placental expulsion? When this substance was first isolated careful experiment was made to ascertain the optimum dosage. It was found that a dose of 0.25 mg. or more by intravenous injection produced, for a few minutes, undesirable side-effects. For that reason 0.125 mg. was recommended-a dose that appeared adequate for therapeutic purposes. Subsequent experience, however, has shown that no serious ill-effect is caused if, in an emergency, 0.25 mg. is given. This dosage now seems to have become well established; indeed, it is by this dose and by this route that ergometrine is most effectively administered. However, to double this already large dose by giving 0.5 mg., as advised in the answer, seems to be unnecessary; it will certainly result in side-effects such as dizziness, a feeling of weight and loss of power in the limbs, and possibly vomiting. The 0.5 mg. dose should be reserved for intramuscular injection. With reference to the injection in retained placenta it is stated:" If, however, the placenta does not come away at once, manual removal has to be carried out without delay." Elsewhere are the words:" Even if an hour-glass contraction should result it can be dealt with at leisure once the haemorrhage is controlled." Of these conflicting statements I submit that it is the second that should be accepted, for clearly nothing is gained by a forceful removal of a placenta from a tightly contracted uterus. The chief benefit of ergometrine lies in its ability to convert a relaxed uterus into a'contracted uterus; and with that change the post-partum haemorrhage (assuming the bleeding is from the uterus itself) is arrested. Thus, the opportunity is given for the obstetrician to attend to the patient's general condition, to give blood transfusion if necessary, and, if the placenta does not come away, to prepare for the anaesthetic later requiredfor the operation of manual removal. If Crede expression is to succeed it must beperformed as soon as the fundus becomes hard, and before the lower part of the body contracts down in front of the placenta. If the expression fails an hour should be allowed to elapse, after which the uterus will in all likelihood be relaxing at intervals; and the extrac-tion of the placenta then becomes a relatively easy and safe operation.