docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2024-23-5-56-61docru-298Research ArticleОБЗОРЫREVIEWSКонцепция «Менеджмент крови пациенток» в практике акушера-гинеколога: на что обратить внимание?Patient Blood Management Conception in the Practice of an Obstetrician-Gynecologist: What to Pay Attention to?https://orcid.org/0000-0001-6714-6344ФёдороваТ. А.FedorovaT. A.

Фёдорова Татьяна Анатольевна — д. м. н., профессор, заместитель директора Института анестезиологии, реаниматологии и трансфузиологии

117485, г. Москва, ул. Академика Опарина, д. 4

4 Oparina Str., Moscow, 117997

tfedorova1@mail.ruhttps://orcid.org/0000-0002-6926-8414СтрельниковаЕ. В.StrelnikovaE. V.

Стрельникова Елена Владимировна — к. м. н., врач высшей категории отделения экстракорпоральных методов лечения и детоксикации

117485, г. Москва, ул. Академика Опарина, д. 4

4 Oparina Str., Moscow, 117997

e_strelnikova@oparina4.ruФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава РоссииРоссияNational Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. KulakovRussian Federation202420022025235ГИНЕКОЛОГИЯ5661Copyright © Фёдорова Т.А., Стрельникова Е.В., 20252025Фёдорова Т.А., Стрельникова Е.В.Fedorova T.A., Strelnikova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://docru.elpub.ru/jour/article/view/298Цель обзора

Цель обзора. Представить литературные и собственные данные по внедрению концепции «Менеджмент крови пациентки» (МКП) в акушерстве и гинекологии.

Основные положения

Основные положения. МКП предполагает «своевременное междисциплинарное применение научно обоснованных мультимодальных медицинских и хирургических концепций, направленных на скрининг, диагностику и соответствующее лечение анемии, минимизацию хирургических, процедурных, ятрогенных кровопотерь и контроль коагулопатических кровотечений для улучшения показателей здоровья посредством помощи, ориентированной на пациента». В рамках МКП акушеру-гинекологу важно провести скрининг на дефицит железа (ДЖ) и выявить железодефицитную анемию (ЖДА), назначить лечение современными препаратами железа. Предлагается препарат двухвалентного железа новой генерации с пролонгированным высвобождением, что минимизирует побочные эффекты терапии. Второй аспект — скрининг и лечение выявленных нарушений коагуляции с использованием алгоритмов терапии, составленных по данным тромбоэластометрии; третий аспект — скрининг и лечение анемии, контроль коагуляции, мониторинг кровопотери и рациональное применение аллогенных компонентов крови в послеродовом/послеоперационном периоде. Представлены результаты внедрения МКП в клиническую практику ФГБУ «НМИЦ АГП им. В.И. Кулакова», что позволяет проводить своевременную диагностику ДЖ и ЖДА в центре «Анемия-СТОП!» и рациональное переливание аллогенных компонентов крови и способствует уменьшению объемов заготавливаемых и переливаемых компонентов донорской крови.

Заключение

Заключение. Внедрение концепции МКП и сохранения собственной крови пациентки повышает эффективность и безопасность лечения, одновременно содействуя наилучшему использованию экономических ресурсов.

Aim

Aim. To present literature and own data on the implementation of the concept of patient blood management (PBM) in obstetrics and gynecology.

Key points

Key points. PBM involves “the timely, interdisciplinary application of evidence-based, multimodal medical and surgical concepts aimed at screening, diagnosing and appropriately treating anemia, minimizing surgical, procedural, iatrogenic blood loss, and managing coagulopathy bleeding to improve health outcomes through patient-centered care”. As part of the PBM, it is important for the obstetriciangynecologist to first screen for iron deficiency (ID) and identify iron deficiency anemia (IDA), prescribe treatment with modern iron preparations. A new generation of ferrous iron preparation with prolonged release is proposed, which minimizes the side effects of therapy. The second aspect is to screen and treat identified coagulation disorders using treatment algorithms based on thromboelastometry data, the third is in the postpartum/postoperative period, screen for and treat iron deficiency and anemia, control coagulation, monitor blood loss and rational use of allogeneic blood components. The results of the introduction of PBM into clinical practice of the National Medical Research Center for Obsterics, Gynecology and Perinatology named after Academician V.I. Kulakov, which allows for timely diagnosis of ID and IDA at the “Anemia-STOP!” Center, rational transfusion of allogeneic blood components, which contributed to a reduction in the volume of procured and transfused donor blood components.

Conclusion

Conclusion. The implementation of the PBM concept helps to improve the effectiveness and safety of treatment, while promoting the best use of economic resources.

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The authors declare that there are no conflicts of interest present.