术中自体血液回输对剖宫产产妇术后凝血功能及炎症反应的影响  

Effect of intraoperative autologous blood transfusion on coagulation function and inflammation after cesarean section

作　　者：尹坚银 李爱媛[1] 陈亮[1] Yin Jianyin;Li Aiyuan;Chen Liang(Department of Anesthesiology,Hunan Provincial Maternal and Child Health Care Hospital,Changsha 410008,China)

机构地区：[1]湖南省妇幼保健院麻醉科,长沙410008

出　　处：《中国医师杂志》2020年第8期1153-1156,共4页Journal of Chinese Physician

基　　金：湖南省科技计划项目(2018JJ6009);湖南省卫生计生委科研计划课题横向项目(B2016070)。

摘　　要：目的探讨术中自体血液回输对剖宫产产妇术后凝血功能及炎症反应的影响。方法采用回顾性分析方法,选取2017年3月至2019年2月于本院行剖宫产术并且术中有输血的单胎产妇114例,根据术中输血血液来源不同将产妇分为自体组(57例)及异体组(57例)。分别于术前及术后3 d检测并记录两组凝血标志物、炎症反应指标的变化,同时比较两组输血后的并发症发生情况。结果术后3 d,两组P65 mRNA表达及P65光密度值均明显升高(P<0.01),但自体组低于异体组(P<0.01);两组粒细胞-巨噬细胞集落刺激因子(GM-CSF)、白细胞介素-6(IL-6)、IL-1β均出现明显升高,但自体组低于异体组(P<0.01);两组D-二聚体(D-D)、血栓调节蛋白(TM)、组织型纤溶酶原激活物(t-PA)、纤溶酶-抗纤溶酶复合物(PAP)均略高于术前,但差异均无统计学意义(P>0.05);此外,自体组并发症发生率为5.26%(3/57),明显小于异体组的17.54%(10/57),组间差异有统计学意义(χ2=4.25,P=0.04)。结论剖宫产术中行自体血液回收处理并回输后对产妇凝血功能无明显影响,但相较于异体输血,自体血液回输更能有效降低产妇术后炎性反应,对术后并发症的发生亦具有显著的降低作用,有利于改善预后。Objective To explore the effect of intraoperative autologous blood transfusion on coagulation function and inflammatory reaction after cesarean section.Methods By retrospective analysis,114 parturients who underwent caesarean section in our hospital from March 2017 to February 2019 with intraoperative blood transfusion were selected and divided into autologous group(57 cases)and allogeneic group(57 cases)according to the source of intraoperative blood transfusion.The changes of coagulation markers and inflammatory reaction indexes were detected and recorded respectively before and 3 days after operation,respectively.And the complications after blood transfusion were compared between the two groups.Results On the 3rd day after operation,the expression of P65 gene and the optical density of P65 in both groups increased significantly,but the autogenous group was lower than the allogeneic group(P<0.01);the granulocyte-macrophage colony-stimulating factor(GM-CSF),interleukin(IL)-6 and IL-1βin both groups increased significantly,but the autogenous group was lower than the allogeneic group(P<0.01);the D-dimer(D-D),thrombomodulin(TM),tissue plasminogen activator(t-PA)and fibrinolytic-antifibrinolytic complex(PAP)in both groups were slightly higher than those before operation,and the data between the two groups also changed,but with no statistical significance(P>0.05).In addition,the incidence of complications in the autogenous group was 5.26%(3/57),which was significantly lower than that in the allogeneic group(17.54%,10/57)(χ2=4.25,P=0.04).Conclusions Autologous blood transfusion has no significant effect on the coagulation function of parturients during cesarean section,but compared with allogeneic blood transfusion,autologous blood transfusion can effectively reduce the inflammatory reaction of parturients after operation,and has a significant effect on reducing the occurrence of complications after operation,which is conducive to improving the prognosis.

关 键 词：剖宫产术 输血 自体 血液凝固试验 炎症 

分 类 号：R719.8[医药卫生—妇产科学]