产后出血处置(1).ppt

1.出血量估计 4个100方案----失血量估计 血压100mmHg，心率100次/分钟，尿量100mml/小时 出血量100X10mml 广州孕产妇救治中心 根据出血量及临床表现进行分度 1 grade I (blood loss 15%, without hemodynamic signs or symptoms) 2 grade II (blood volume loss of 20–25%, accompanied by tachycardia, tachypnea, and hypotension) 3 grade III (blood volume loss of 30–35%, when earlier signs added cold extremities and/or oliguria) 4 grade IV (blood volume loss ≥40% and having everything described before plus altered sensory. 产后出血量与临床体征关系 Conclusion: We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed 休克指数=心率/收缩压 0.5----------------正常 =1-----------------轻度休克，失血20%－30% 1-----------------休克 1.5---------------严重休克，失血30%－50% 2-----------------重度休克，失血50% 丢失血容量计算 血液稀释法，抽出的血容量（V）或最佳初期血细胞比容（Hct）可由以下公式算出： V=EBV?(Hcti?Hctf)/Hctav （EBV是估计血容量、Hctf是最低血细胞比容、Hctav是平均血细胞比容 [(Hcti?Hctf)/2]） 注意点：HCT受诸多因素影响 We do not recommend the use of single Hct measurements as an isolated laboratory marker for bleeding (Grade 1B） 2.补充血容量.About time 1. definition of haemorrhagic shock , (SBP ≤ 90 mmHg and BE ≤-6 mmol/l), 2. expected and ongoing bleeding (not meeting haemorrhagic shock criteria, but with either prehospital blood loss and/or expected further blood loss intraoperatively due to the need for multiple procedures) 3. dropping Hb (Hb drop to below 80 g/l or below 100 g/l and 30 g/l drop within 2 h 4. low SBP (persistent hypotension on serial measurements