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Article(id=1210676785717580731, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1210676785113600955, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.05.12, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1609776000000, receivedDateStr=2021-01-05, revisedDate=1615478400000, revisedDateStr=2021-03-12, acceptedDate=null, acceptedDateStr=null, onlineDate=1766577439001, onlineDateStr=2025-12-24, pubDate=1622131200000, pubDateStr=2021-05-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766577439001, onlineIssueDateStr=2025-12-24, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766577439001, creator=13701087609, updateTime=1766577439001, updator=13701087609, issue=Issue{id=1210676785113600955, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='5', pageStart='425', pageEnd='530', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766577438858, creator=13701087609, updateTime=1766718730270, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269404306838321, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1210676785113600955, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269404306838322, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1210676785113600955, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=498, endPage=503, ext={EN=ArticleExt(id=1210676786015376318, articleId=1210676785717580731, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress of fibrinogen in the clinical assessment and treatment of postpartum hemorrhage, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Postpartum hemorrhage is the most common cause of maternal death worldwide with an upward trend of incidence recent years. There are many reasons leading to postpartum hemorrhage with very complicated pathogenesis. Recent years, various studies have found that a close relationship existed between the plasma fibrinogen concentration and postpartum hemorrhage and its severity. Prenatal fibrinogen detection is helpful to predict the occurrence of severe postpartum hemorrhage, Detection of postpartum fibrinogen level, and timely correction of transient coagulation dysfunction is an important way to remedy severe postpartum hemorrhage. At the present stage, many domestic hospitals have taken prenatal fibrinogen detection as a routine test item, but it has not yet been taken as an independent risk factor for postpartum hemorrhage. At the same time, the fibrinogen threshold might leading to severe postpartum hemorrhage and whether the lowest fibrinogen level is related to the amount of bleeding are still uncertain. The present review summarized the research progress of the clinical application of plasma fibrinogen measurement in the prediction of severe postpartum hemorrhage and accurate assessment of the amount of bleeding when postpartum hemorrhage occurs, and to explore the clinical value of fibrinogen detection in postpartum hemorrhage. Meanwhile, Suggestions for relative clinical work and future research are presented in order to improve the prognosis of postpartum hemorrhage.

, correspAuthors=Li Li, authorNote=null, correspAuthorsNote=
*E-mail:
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产后出血是当前导致孕产妇死亡最常见的病因，且其发病率有上升趋势。产后出血有多种原因，其机制也不尽相同。近年来各项研究发现，产后出血及其严重程度与产妇血浆纤维蛋白原的关系十分密切，检测产前纤维蛋白原水平有助于预判严重产后出血的发生，而检测产后纤维蛋白原水平、及时纠正产后出血时的一过性凝血机能异常是救治严重产后出血的重要方法。现阶段虽然国内许多医院已将产前纤维蛋白原作为常规检测项目，但尚未将其作为产后出血的独立危险因素，且可能导致严重产后出血的纤维蛋白原临界值及纤维蛋白原最低值与出血量有无关联尚无定论。该文就血浆纤维蛋白原检测用于产前预判严重的产后出血，以及在产后出血发生时精确评估出血量的研究进展进行总结，探讨纤维蛋白原在产后出血临床救治中的作用，并提出在临床工作及未来研究中的相关建议，以期改善产后出血产妇的预后。

, correspAuthors=李力, authorNote=null, correspAuthorsNote=
李力，E-mail：
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蒋一逍，硕士研究生，主要从事妇产科临床治疗方面的研究

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蒋一逍，硕士研究生，主要从事妇产科临床治疗方面的研究

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蒋一逍，硕士研究生，主要从事妇产科临床治疗方面的研究

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纤维蛋白原在产后出血中的临床应用研究进展
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蒋一逍 , 李力 * , 刘宿 , 古星 , 朱大伟 , 黄畅晓 , 邹燕珂
解放军医学杂志 | 综述 2021,46(5): 498-503
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解放军医学杂志 | 综述 2021, 46(5): 498-503
纤维蛋白原在产后出血中的临床应用研究进展
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蒋一逍, 李力* , 刘宿, 古星, 朱大伟, 黄畅晓, 邹燕珂
作者信息
  • 陆军军医大学大坪医院/陆军特色医学中心产科，400010 重庆

    • 蒋一逍，硕士研究生，主要从事妇产科临床治疗方面的研究

通讯作者:

李力，E-mail：
Research progress of fibrinogen in the clinical assessment and treatment of postpartum hemorrhage
Yi-Xiao Jiang, Li Li* , Su Liu, Xing Gu, Da-Wei Zhu, Chang-Xiao Huang, Yan-Ke Zou
Affiliations
  • Department of Obstetrics, Daping Hospital/Army Medical Center, Chongqing 400010, China
出版时间: 2021-05-28 doi: 10.11855/j.issn.0577-7402.2021.05.12
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摘要
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产后出血是当前导致孕产妇死亡最常见的病因，且其发病率有上升趋势。产后出血有多种原因，其机制也不尽相同。近年来各项研究发现，产后出血及其严重程度与产妇血浆纤维蛋白原的关系十分密切，检测产前纤维蛋白原水平有助于预判严重产后出血的发生，而检测产后纤维蛋白原水平、及时纠正产后出血时的一过性凝血机能异常是救治严重产后出血的重要方法。现阶段虽然国内许多医院已将产前纤维蛋白原作为常规检测项目，但尚未将其作为产后出血的独立危险因素，且可能导致严重产后出血的纤维蛋白原临界值及纤维蛋白原最低值与出血量有无关联尚无定论。该文就血浆纤维蛋白原检测用于产前预判严重的产后出血，以及在产后出血发生时精确评估出血量的研究进展进行总结，探讨纤维蛋白原在产后出血临床救治中的作用，并提出在临床工作及未来研究中的相关建议，以期改善产后出血产妇的预后。

产后出血  /  凝血功能障碍  /  纤维蛋白原

Postpartum hemorrhage is the most common cause of maternal death worldwide with an upward trend of incidence recent years. There are many reasons leading to postpartum hemorrhage with very complicated pathogenesis. Recent years, various studies have found that a close relationship existed between the plasma fibrinogen concentration and postpartum hemorrhage and its severity. Prenatal fibrinogen detection is helpful to predict the occurrence of severe postpartum hemorrhage, Detection of postpartum fibrinogen level, and timely correction of transient coagulation dysfunction is an important way to remedy severe postpartum hemorrhage. At the present stage, many domestic hospitals have taken prenatal fibrinogen detection as a routine test item, but it has not yet been taken as an independent risk factor for postpartum hemorrhage. At the same time, the fibrinogen threshold might leading to severe postpartum hemorrhage and whether the lowest fibrinogen level is related to the amount of bleeding are still uncertain. The present review summarized the research progress of the clinical application of plasma fibrinogen measurement in the prediction of severe postpartum hemorrhage and accurate assessment of the amount of bleeding when postpartum hemorrhage occurs, and to explore the clinical value of fibrinogen detection in postpartum hemorrhage. Meanwhile, Suggestions for relative clinical work and future research are presented in order to improve the prognosis of postpartum hemorrhage.

postpartum hemorrhage  /  coagulation disorder  /  fibrinogen
蒋一逍, 李力, 刘宿, 古星, 朱大伟, 黄畅晓, 邹燕珂. 纤维蛋白原在产后出血中的临床应用研究进展. 解放军医学杂志, 2021 , 46 (5) : 498 -503 . DOI: 10.11855/j.issn.0577-7402.2021.05.12
Yi-Xiao Jiang, Li Li, Su Liu, Xing Gu, Da-Wei Zhu, Chang-Xiao Huang, Yan-Ke Zou. Research progress of fibrinogen in the clinical assessment and treatment of postpartum hemorrhage[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (5) : 498 -503 . DOI: 10.11855/j.issn.0577-7402.2021.05.12
正文
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产后出血(postpartum hemorrhage，PPH)是一种常见的分娩并发症，通常指胎儿经阴道娩出后24 h内出血>500 ml或剖宫产后出血>1000 ml[1-3]。根据BJOG指南(2017)，产后出血可分为少量产后出血(500~1000 ml)与大量产后出血(>1000 ml)，大量产后出血又可被细分为中等产后出血(1001~2000 ml)与严重产后出血(>2000 ml)[4]。严重产后出血易导致失血性休克、弥漫性血管内凝血等严重并发症，危及产妇生命。近年来，产后出血发生率在世界各地均有上升趋势。流行病学调查显示，进入21世纪以来，产后出血的发生率从1.9‰升高至4.2‰，是目前全世界产妇死亡的主要原因[5-7]。产后出血的原因较多，包括子宫收缩乏力、软产道裂伤、胎盘因素及凝血功能障碍等，这些因素可合并存在，也可互为因果，发生机制也不相同。早期发现和预防产后出血是产科临床工作的重点。因此，在各级医院如何及时采取简单有效的方法预测产后出血的发生，采用何种实验室检查来指导产后出血的治疗十分重要[8-10]。
现阶段认为，凝血功能紊乱是导致产后出血的重要原因之一。妊娠时期母体凝血功能发生了显著的变化，在促凝物质浓度升高的同时还存在抗凝物质的减少，从而使孕妇处于高凝状态[11]。然而，部分患者由于血液稀释、凝血功能紊乱等原因导致的产前凝血功能下降及产后失血导致的凝血因子流失，增加了发生严重产后出血甚至产后弥漫性血管内凝血的风险[12]。相关研究发现，有产后出血与无产后出血的患者血浆部分凝血物质含量存在差异[13-14]。进一步研究发现，发生严重产后出血的患者血浆纤维蛋白原(fibrinogen，FIB)水平低于正常及无严重产后出血的患者，且血浆纤维蛋白原水平与出血量相关[15-16]。因此，测定血浆FIB水平有助于预判严重产后出血的发生，且对预估产后出血量有一定价值。
1 妊娠期血液及凝血功能的改变
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为了适应妊娠及分娩，妊娠期女性体内各系统的精细调控发生了改变。其中，血液系统的变化较为明显，妊娠早期血容量即开始增加，从而出现稀释性贫血，晚期时则因各种凝血因子浓度的改变而处于高凝状态[17-18]。孕妇的生理变化是妊娠及分娩所必需的，但此变化也更容易使孕妇罹患子痫前期、特发性血小板减少性紫癜、产后出血等妊娠及分娩并发症[18-19]。
1.1 血容量增加与稀释性贫血
由于胎儿生长以及子宫和乳腺增生的需要，妊娠早期血容量即上升，且血浆增多的比例高于血红蛋白，因此，妊娠期女性易出现稀释性贫血，但其发生时间及严重程度在不同种族人群中略有不同。一项针对中国女性妊娠期生化及血液参数的研究发现，与成年未孕女性(110~160 g/L)比较，孕妇在妊娠前3个月的血红蛋白(100~143 g/L，平均值128 g/L)明显下降，在妊娠最后3个月进一步下降(83~136 g/L，平均值112 g/L)，且有32.4%的孕妇血红蛋白低于正常值下限[20]。与欧洲国家的同类研究比较，中国女性在妊娠期的血红蛋白水平下降更明显，更容易发生稀释性贫血[20-22]。
妊娠期稀释性贫血可增加产后出血的发生风险，尤其是胎儿娩出后短时间内的迅速出血。有研究发现，分娩前血红蛋白<90 g/L的孕妇在分娩期的出血量明显高于无贫血的孕妇，并指出这可能与贫血导致子宫平滑肌收缩功能下降进而引起子宫收缩乏力有关[21]。可见，妊娠期稀释性贫血是产后出血的危险因素之一。
1.2 妊娠期凝血功能的生理变化
女性在妊娠期各项凝血参数均发生了明显变化。血浆内FⅤ、FⅦ、FⅧ、FⅨ、FⅩ、FⅫ等促凝物质及FIB升高，同时抗凝物质FⅪ、FⅩⅢ、肝素、活性蛋白C减少，从而导致孕晚期及分娩期血液处于高凝状态，有助于降低分娩期间发生大出血的风险[17-20]。妊娠期的凝血功能变化非常复杂，且个体间的差异较大，目前不同孕周各项凝血指标的正常值范围尚未形成共识。综合不同国家的研究结果，活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)在妊娠早期与晚期无明显改变，凝血酶时间(TT)在妊娠早期及晚期出现轻度下降，而FIB及D-二聚体在妊娠期呈进行性升高[21-23]。
1.3 凝血功能紊乱与产后出血
妊娠期凝血功能出现轻微紊乱即可导致诸多孕期并发症，产后出血是较常见的一种分娩并发症。多项研究结果显示，在产后出血患者中，存在凝血功能障碍者占25%~60%[12,14]。分娩时即存在的凝血功能紊乱以及大出血导致的凝血功能失调均可能增加严重产后出血的发生风险。可能导致凝血功能紊乱的基础疾病包括特发性血小板减少性紫癜、子痫前期、高脂血症、肝炎、肝硬化等。相比之下，出血导致的凝血物质消耗所引起的继发性凝血功能紊乱是加重产后出血严重程度及引起严重并发症更重要的因素。发生产后出血时，血液流失伴随着血小板、FIB等促凝物质大量消耗，导致凝血功能低下而进一步加重产后出血，严重时可导致失血性休克、弥漫性血管内凝血等严重并发症，危及产妇生命[24]。
传统的凝血功能检查包括APTT、PT、TT、血浆D-二聚体测定及FIB定量等，但这些常规检查的特异性不强，假阳性率、假阴性率高，灵敏度也较低[25]。因此，部分凝血功能检查正常的孕妇仍然在分娩时发生了伴随凝血功能紊乱的产后出血，且许多常规检查结果等待时间较长，从而限制了其在严重产后出血评估中的应用。
2 FIB与产后出血的关系
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FIB是参与生理性血液凝固的重要组成部分，其血浆水平过高或过低均会导致凝血功能紊乱。未孕状态下，血浆FIB正常水平为3~4 g/L，而妊娠时血浆FIB水平可提升至4~6 g/L[26]。FIB是参与血液凝固最终阶段最重要的凝血物质之一，其水平低下可能导致或加重各种出血性疾病，包括产后出血。产妇在孕期的血液稀释、产后出血引起的凝血因子稀释及大量消耗是导致低FIB血症的主要原因。已有多项研究证实，严重产后出血的产妇在妊娠期间血浆FIB水平明显低于正常水平，且血浆FIB水平与产后出血的失血量及发展进程密切相关[27-28]。随着实验室和临床研究的进一步深入，以及各种快速准确的血浆FIB检测方法的临床应用，血浆FIB被认为是一个可用于临床预判严重产后出血并有效评估其严重程度的潜在指标[29]。
2.1 FIB对严重产后出血的预判价值
针对产后出血孕妇凝血功能的研究测定了各项凝血指标，并分析了这些凝血指标在产后出血进展中的变化情况。其中，英国一项针对18 501名产妇的研究发现，血红蛋白在发生严重产后出血时平均下降了35 g/L，但血红蛋白下降的数值与失血量并无明显关系，推测这与产妇血液浓缩、大量输血输液等多项因素有关[21]。此外，该研究中的PT及APTT中位值在大部分发生严重产后出血的产妇中仍处于正常范围，虽然在失血量>1500 ml时有所升高(PT升高比例为12.5%，APTT为22.0%)，但其升高幅度与失血量及是否需要输注红细胞治疗几乎不相关。然而，在发生需要输注红细胞的严重产后出血时产妇的血浆FIB平均值仅为3.3 g/L，明显低于健康产妇的4.1 g/L，同时其下降程度随失血量的增加而增多；但部分患者在失血量较少(<1000 ml)时也会出现FIB水平的明显变化[21,25]。当需输注>4 U的红细胞时血浆FIB将下降至2.2 g/L。另一方面，当发现PT、APTT等指标出现异常时，产后出血往往已经进入较为严重的阶段，此时相当一部分产妇已经接受了输血治疗或有创治疗[30]。由此可见，血红蛋白、PT、APTT等指标对评估产后出血量的价值有限，而FIB的动态变化是反映凝血功能较为敏感的指标。
2.2 FIB对产后出血严重程度的评估作用
产后出血与严重产后出血被认为是同一种疾病的不同阶段，严重产后出血发病原因更为复杂，检查及治疗更加困难[4-5]。许多研究证实，产后血浆FIB水平下降可增加产后出血的风险，并推荐在疑似患者或产后出血早期测定血浆FIB水平并动态观察其变化趋势以预防严重产后出血。Collis等[31]在研究有无严重产后出血患者凝血物质水平的差异时发现，在FIB、血小板数量、FⅡ、FⅤ、D-二聚体、蛋白C抗原等多种反映凝血功能的指标中，无严重产后出血组的血浆FIB水平基本保持稳定，但严重产后出血组血浆FIB最初4 h即开始持续下降，是唯一随着失血量的增加而明显下降且不受其他因素影响的指标。此外，有研究发现，在诊断产后出血的首次检测中，严重产后出血产妇的血浆FIB水平已下降至3.3 g/L；当血浆FIB>3.0 g/L时，发生>2500 ml失血的概率极低；当FIB水平在2.0~2.9 g/L时，失血>2500 ml的可能性较大；而当FIB<2.0 g/L时，进展为严重产后出血的阳性预测值高达100%[21]。一项纳入738例产后出血患者的调查发现，发生严重产后出血(指存在以下情况中的任意一种：血红蛋白下降>40.0 g/L；输注浓缩红细胞；紧急外科手术；获得加强监护；死亡)时FIB平均值为3.4 g/L，而无严重产后出血时则为4.2 g/L。同时，与FIB>3.0 g/L比较，FIB水平在2.0~2.9 g/L与<2.0 g/L者发生严重产后出血的校正OR值分别为1.90及11.99[32]。目前，采用凝血酶比浊法(Clauss法)测定FIB可在10~20 min内获得结果，在所有凝血功能检测中最为快速。更重要的是，FIB作为产后出血的独立预测因子，在发生产后出血时不受血红蛋白含量、凝血因子及分娩方式等其他因素的影响[21,32]。因此，测定血浆FIB水平是一种快速、精确评估产后出血严重程度的方法，可为救治产后出血提供参考。
失血量是评估产后出血严重程度以及决定其治疗方案的重要指标。目前，“目测法”是各级医疗机构判断产后出血量的主要方法之一，但准确率不高且十分依赖产科医师的个人经验。国外既往研究发现，不同程度的出血量所测得的FIB水平不同，当失血量<2000 ml时，FIB水平为4 g/L；失血量为2500 ml时，FIB水平为3 g/L；当失血量>4000 ml时，FIB水平则<2 g/L[21]。但是，目前国内外对产后出血失血量与FIB水平的关系并未达成共识，可能是由于不同研究中患者种族、检测手段及时间不一致等原因所致。
目前，对产前FIB水平预测产后出血价值的认识仍有待提高。近期研究显示，在合并HELLP综合征(溶血、肝功能损伤、血小板低下)的产妇中，发生产后出血者的产前FIB水平明显低于未发生产后出血者，提示产前FIB是预测HELLP综合征患者发生产后出血的独立危险因素[33]。因此，产前及产后密切监测FIB水平对于预判产后出血以及早期阶段产后出血量的精确评估均有一定价值。
3 FIB在产后出血中的临床应用
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现阶段尚缺乏产后出血凝血功能紊乱检测及干预的完善指南，产后出血的治疗主要依赖产科医师对出血量的主观判断。随着FIB对产后出血评估价值的进一步明确，越来越多的医疗及研究机构在产后出血的临床治疗中开始动态测定血浆FIB，以指导产后出血的凝血功能管理及治疗[34]。同时，在临床实践中处理大量产后出血导致的失血性休克时，重视监测并积极纠正凝血功能紊乱，可有效减少患者的失血量及血制品输注量。
目前，我国各级医院在临床工作中极少将血浆FIB作为评估产后出血风险、判断产妇凝血功能情况的重要指标，分析可能的原因主要有以下几点：(1)缺乏足够的实验证据，在临床工作中如何运用FIB早期诊断并指导产后出血的治疗尚不明确。不同国家的多中心联合研究是获取一致结论并制定有关FIB在临床工作中应用指南的关键。同时，现阶段尚无中国人群的类似研究，对不同种族产妇血浆FIB的差异也未进行分析。(2)缺乏产前与产后FIB对比的相关研究。目前的研究集中于发生产后出血时FIB的情况，但部分发生产后出血的孕妇在产前即存在血浆FIB水平较低的情况，尚缺乏产前FIB水平与产后出血发生风险关系的研究。(3)我国医疗机构尚缺乏针对产后出血患者进行FIB快速检测的有效手段。
3.1 FIB的快速检测手段
在法国、澳大利亚、日本等发达国家，FIB的快速检测已应用于临床，其方法包括Clauss法、黏弹性测试等，被称为即时检验(point-of-care testing，POCT)[35]。POCT现在已用于快速检测FIB水平以评估产妇凝血功能并指导进一步的诊断及治疗，其中，Clauss法可快速准确测定血浆FIB水平。有研究发现，当产前血浆FIB水平<2 g/L时预示着可能发生严重的产后出血[15-16]。然而，此数值并不是绝对的，相当一部分产前血浆FIB水平>2 g/L的产妇也有进展为严重产后出血的风险，因此需结合临床实际情况加以评估[36]。
威胁产妇生命的严重产后出血发展迅速，快速而准确地测定血浆FIB水平及功能对有效评估产妇凝血功能并采取有效手段遏制产后出血十分重要。近年来，血栓弹力描记图中对功能性FIB的测定已批准上市，床旁定量检测FIB功能得以实现。血栓弹力描记图包括血栓弹力图(TEG)及旋转式血栓弹力图(ROTEM)。Clauss法及血栓弹力描记图测定均为快速而准确的FIB测定方法，可在10 min内获得结果。TEG可用于检测血小板的功能，同时也可检测FIB活性。但相比较而言，TEG在产后出血检测方面或许存在一定的偏差，ROTEM对凝血功能的测定更加精确，而Clauss法检测仪器的床旁移动及基层推广有一定难度，因此，上述方法在产后出血评估中的作用仍有待进一步研究确定[37-40]。
3.2 产后出血中的FIB治疗
在产后出血的治疗方面，提高FIB含量是纠正凝血功能紊乱的重要措施。目前，治疗产后出血凝血功能紊乱最重要的手段是输注新鲜冰冻血浆[41]。然而，新鲜冰冻血浆存在的明显缺点限制了其治疗效果：新鲜冰冻血浆中FIB含量一般为2~4 g/L，低于产妇正常血浆FIB含量；新鲜冰冻血浆使用前的准备时间过长，对于快速大量出血的产妇非常不利。研究表明，针对低FIB血症的孕产妇，使用FIB浓缩物置换可将FIB含量提升至正常水平，并可减少失血量，以及浓缩红细胞、血小板等血制品的输注量[41-43]。
虽然血浆FIB有望成为指导冷沉淀、新鲜冰冻血浆等血液制品输注的指标，但目前并未见相关研究确定在产后出血进展至何种程度时输注FIB浓缩物，且盲目提升FIB水平可能会加重血液高凝状态并增加血栓形成的风险。Wikkelsø等[28]研究发现，FIB水平正常(平均4.5 g/L)的产妇提前输注26 mg/kg的FIB对产后出血的结局无明显影响。另一项双盲随机试验发现，针对发生产后出血且FIB指标正常(或Fibtem A5>15 mm)的产妇输注浓缩FIB并不能改善预后；同时该研究还指出，FIB水平>2 g/L(或Fibtem A4>12 mm)的产妇无需置换FIB[27]。
4 总结与展望
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近年来，FIB与产后出血的关系越来越受到关注，血浆FIB有望成为一种可用于评估产后出血严重程度及预判出血量的客观指标，其水平<3 g/L预示着产后出血量有超过2500 ml的风险，而<2 g/L时严重产后出血的发生率达100%。血浆FIB是唯一不受其他因素影响的生物标志物，可快速精确地预判严重产后出血，有助于指导治疗。POCT可准确快速地测定血浆FIB，有望成为一种快速、客观地评估出血量的方式，并可指导冷沉淀、新鲜冰冻血浆等血液制品的输注。然而，由于不同国家人群存在种族、产妇生理状况等方面的差异，血浆FIB水平用于产后出血量等重要指标的精确评估，指导产后出血时凝血功能的管理等实际应用仍有待进一步论证并制定指南。产后出血导致的各种并发症从本质上来说可归为失血性休克的不同类型。因此，如何快速、简便地判断患者或伤员的凝血状态，尽快确定诊断并采取有效的干预手段，值得各个学科进行联合研究。
基金
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  • 国家自然科学基金(31470886)
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2021年第46卷第5期
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doi: 10.11855/j.issn.0577-7402.2021.05.12
  • 接收时间：2021-01-05
  • 首发时间：2025-12-24
  • 出版时间：2021-05-28
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  • 收稿日期：2021-01-05
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国家自然科学基金(31470886)
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    陆军军医大学大坪医院/陆军特色医学中心产科，400010 重庆

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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