洗涤式血液回收用于前置胎盘产妇剖宫产术的回顾性队列研究  

Intraoperative blood salvage for puerpera underwent cesarean section with placenta praevia:a retrospective cohort study

作　　者：田亮 张杰 张鹏 吕倩茹 李朝阳 Tian Liang;Zhang Jie;Zhang Peng;Lyu Qianru;Li Chaoyang(Department of Anesthesiology,Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen 518000,China)

机构地区：[1]华中科技大学协和深圳医院(南山医院)麻醉科,518000

出　　处：《国际麻醉学与复苏杂志》2020年第8期769-773,共5页International Journal of Anesthesiology and Resuscitation

基　　金：深圳市南山区科技计划项目(2018032)。

摘　　要：目的拟评价洗涤式血液回收用于前置胎盘产妇剖宫产术的有效性、安全性及经济效益。方法回顾2017年1月—2019年1月于华中科技大学协和深圳医院(南山医院)行剖宫产术并在术前经超声或MRI明确诊断为前置胎盘的产妇。依据术中是否使用洗涤式血液回收分为干预组(I组,40例)和对照组(C组,41例)。I组产妇于术前准备全自动洗涤式自体血液回收;C组产妇术中不使用洗涤式血液回收,若满足输血指征则输注异体血。回顾产妇年龄、血常规、凝血功能指标等术前资料,术中出血量、异体血输注情况等术中资料及术后出血量及不良事件发生情况等术后资料。结果两组产妇术中出血量差异无统计学意义(P>0.05)。I组产妇术中平均自体血回输量为(350±88)ml.I组产妇异体RBC输注率及输注量低于C组(P<0.05),两组产妇新鲜冰冻血浆(fresh frozen plasma,FFP)输注率、输注量差异无统计学意义(P>0.05)。两组产妇术后Hb、RBC、纤维蛋白原(fibrinogen,FIB)、血小板(platelet,PLT)较术前降低,术后凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)较术前升高(P<0.05)。两组产妇术后Hb、RBC、PLT及PT、APTT、FIB、TT、术后出血量及产后出血、切口感染、盆腔血肿发生率差异无统计学意义(P>0.05)。结论对于合并前置胎盘行剖宫产术的产妇而言,洗涤式血液回收能显著减少术中异体输血率及异体输血量,且不增加产妇术后不良事件发生风险。Objective This paper aims to evaluate the effect of blood salvage for puerpera underwent cesarean section with placenta praevia.Methods The puerpera who underwent cesarean section in our hospital from January 2017 to January 2019 with clear diagnosis as placenta praevia by ultrasound or magnetic resonance imaging(MRI)were reviewed.The intervention group(group I)and control group(group C)are divided depending on whether using blood salvage or not,with 40 cases in group I and 41 cases in group C.The puerpera in group I received automatic washing autologous blood salvage while the puerperal in group C did not use blood salvage.The puerperal in group C received allogeneic blood transfusion when blood transfusion indications were met.Preoperative data including age,routine blood test and coagulation related indexes were reviewed.Intraoperative blood loss,transfusion of allogeneic blood products and other postoperative data such as postoperative blood loss,incidences of postpartum hemorrhage were also reviewed.Results There was no statistically significant difference in the amount of intraoperative bleeding between the two groups(P>0.05).The average amount of autologous blood transfusion in group I was(350±88)ml.The infusion rate and volume of allogeneic RBC infusion in group I were significantly lower than those values in group C,with statistically significant differences(P<0.05).There was no significant difference in fresh frozen plasma(FFP)infusion rate and infusion volume between the two groups(P>0.05).Hemoglobin(Hb),red blood cell(RBC),platelet(PLT),fibrinogen(FIB)were significantly decreased,while prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)were significantly increased after operation(P<0.05).There was no significant difference in Hb,RBC,PLT,PT,APTT,FIB and TT between the two groups(P>0.05).There was no statistically significant differences in postpartum blood loss,postpartum hemorrhage,incision infection,and incidence of pelvic hematoma between the two groups(P>0.05).Con

关 键 词：术中血液回收 自体输血 前置胎盘 剖宫产术 

分 类 号：R719.8[医药卫生—妇产科学]