急性等容血液稀释在完全性前置胎盘合并胎盘植入剖宫产手术中的应用  

The application of acute normovolemic hemodilution in cesarean section for pregnant women with total placenta praevia and accrete

作　　者：倪燕[1] 周钦海[1] 蒋秀红[1] 丁正年[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2014年第6期571-573,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨急性等容血液稀释(ANH)在完全性前置胎盘合并胎盘植入剖宫产手术中应用的有效性和安全性。方法将52例需剖宫产终止妊娠的完全性前置胎盘合并胎盘植入的产妇随机双盲分为三组:A组在术前进行ANH,B组在术前进行急性高容血液稀释(AHH),C组术前无特殊处理。记录三组产妇术中总出血量、异体血输注例数、术前、术后2h血常规及三组新生儿1、5 min Apgar评分和脐动脉血血气。结果 A、B组产妇急性血液稀释后血气分析差异无统计学意义。A组输注异体血例数明显少于B、C组(P<0.05),术后2 h产妇Hb、Hct、Plt明显高于B、C组(P<0.05),B、C组差异无统计学意义;三组新生儿1、5 min Apgar评分和脐动脉血气分析差异无统计学意义。结论 ANH自体输血对孕妇及胎儿均无不良影响,是一种安全、有效的输血方式。Objective To investigate the efficacy and safety of acute normovolemic hemodilution for pregnant women with total placenta pravia and accreta. Methods Fifty-two pregnant women with placenta praevia and accreta were randomly divided into three groups. Groups A and B received ANH or AHH before the operation while group C received the normal treatment. The total blood loss, transfusion of allogeneie blood and preoperative and postoperative routine blood test were recorded;the infants＇ umblieal artery blood samples were taken immediately after birth,and 1 min, 5 min Apgar scores and the blood gas was analyzied. Results There were no significant difference in the general condition,operation duration,blood loss among the three groups; the transfusion of allogeneic blood in groups B and C were much more than group A （P〈0. 05） ;the postoperative hemoglobin and hematoerit and the count of plateletsin in group A were better than groups B and C （P^0.05） ,while there were no statistically difference between groups B and C; there were not only seldom difference in the Apgar scores of 1 min and 5 min, but also barely change in the blood gas analysis of umbilical artery in new borns from the three groups. Conclusion ANH could play an important role in the prevention of postpartum hemorrhage without doing any harm to the mother and infant.

关 键 词：急性等容血液稀释 完全性前置胎盘 胎盘植入 脐动脉 血气分析 

分 类 号：R614[医药卫生—麻醉学]