摘要
目的 在产前急性大出血患者中实施优化手术室管理路径，探索其急救效果。方法 回顾性分析125例产前急性大出血患者，根据实施优化手术室管理路径时间节点，分为2组，对照组实施常规急救管理路径，观察组实施优化后的急救管理路径，比较两组患者的抢救时间、抢救成功率、术中输血量、术后肾功能损伤发生率、继发性凝血功能障碍发生率、住院天数、住院费用等指标。结果 观察组在抢救时间、术中输血量、术后肾功能损伤发生率、继发性凝血功能障碍发生率、住院天数、住院费用均低于对照组。结论 产前急性大出血患者救治过程中，应用优化手术室急救管理路径，可显著缩短患者抢救时间，减少输血量，缩短住院时间及减少住院费用，值得临床推广应用。
关键词： 急性大出血；手术管理路径；异位妊娠；胎盘早剥；子宫破裂
Abstract
Objective To optimize the operating room management path in patients with acute prenatal massive hemorrhage and explore its first aid effect. Methods a retrospective analysis of 125 patients with prenatal acute hemorrhage, according to the implementation of optimized operating room management path time node, divided into 2 groups, the control group of the conventional first aid management path, observe the implementation of optimized emergency management path, compare the two groups of rescue time, rescue success rate, intraoperative blood transfusion, incidence of postoperative renal function injury, secondary coagulation dysfunction incidence, hospitalization days, hospitalization costs and other indicators. Results The observation group had lower duration of rescue, intraoperative blood transfusion, the incidence of postoperative renal impairment, the incidence of secondary coagulopathy, hospitalization days and hospitalization cost than the control group. Conclusion In the treatment process of patients with acute severe hemorrhage, optimizing the emergency management path in the operating room can significantly shorten the rescue time of patients, reduce the amount of blood transfusion, shorten the hospitalization time and reduce the hospitalization cost, which is worthy of clinical promotion and application.
Key words： acute massive bleeding, surgical management path, ectopic pregnancy, placental abruption, uterine rupture
参考文献 References
[1] Deena Elkafrawi, Giovanni Sisti, Sarah Araji, et al. Risk Factors for Neonatal/Maternal Morbidity and Mortality in African American Women with Placental Abruption[J]. Medicina (Kaunas, Lithuania), 2020, 56(4).
[2] Andrea Tinelli, Ioannis P Kosmas, Jose Tony Carugno, et al. Uterine rupture during pregnancy: The URIDA (uterine rupture international data acquisition) study[J]. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2022, 157(1): 76-84.
[3] Lakmini Pinnaduwage, Joanne Honeyford, Elyse Lackie, et al. The Sustained Value of an Early Pregnancy Assessment Clinic in the Management of Early Pregnancy Complications: A 10-Year Retrospective Study[J]. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2018, 40(8): 1017-1023.
[4] Arezoo Karimi, Kourosh Sayehmiri, Mojtaba Vaismoradi, et al. Vaginal bleeding in pregnancy and adverse clinical outcomes: a systematic review and meta-analysis[J]. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 2024, 44(1): 2288224.
[5] Qing Liu, Liping Yang, Qingrong Peng. Artificial Intelligence Technology-Based Medical Information Processing and Emergency First Aid Nursing Management [J]. Computational and mathematical methods in medicine, 2022, 2022: 8677118. DOI: 10.1155/ 2022/ 8677118.
[6] 赵丹丹,王乐瑶,张崇巽,施鸿珊,高翔羽. 2023年美国心脏协会和美国儿科学会新生儿复苏指南更新要点解读[J]. 中华新生儿科杂志（中英文）,2024,01:8-12.
[7] M Azongmo, L Zhu, N Lorenzo-Villalba, et al. [A particular state of shock: spontaneous rupture of a heterotopic pregnancy][J]. Revue medicale de Liege, 2023, 78(1): 21-23.
[8] 黄祝疆,罗超容,张锦新,等. 介入治疗中央性前置胎盘产前大出血的护理措施分析 [J]. 黑龙江医药, 2018, 31 (02): 461-463.