稀释式和回收式自体血回输在凶险性前置胎盘剖宫产中止血效果及对母婴结局影响  

Hemostatic effects of dilute and recovered autologous blood transfusions during a cesarean section in placenta previa and their effects on maternal and infant outcomes

作　　者：聂鑫[1] 丁杰[1] 孙彩凤[2] NIE Xin;DING Jie;SUN Caifeng(Department of Anesthesiology,Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University,Jiangsu Province,Changzhou 213000,China;Department of Obstetrics and Gynecology,Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University,Jiangsu Province,Changzhou 213000,China)

机构地区：[1]南京医科大学附属常州市妇幼保健院麻醉科,江苏常州213000 [2]南京医科大学附属常州市妇幼保健院妇产科,江苏常州213000

出　　处：《中国医药导报》2020年第32期79-82,99,共5页China Medical Herald

基　　金：江苏省妇幼健康科研项目合同书(F201545)。

摘　　要：目的探讨稀释式和回收式自体血回输在凶险性前置胎盘剖宫产中止血效果及对母婴结局的影响。方法选取2017年1月—2020年2月于南京医科大学附属常州市妇幼保健院妇产科行剖宫产术的凶险性前置胎盘的产妇80例,根据自体血回输方式的不同分为稀释组(稀释式自体血回输)和回收组(回收式自体血回输)。于采血前(T1)、采血后即刻(T2)、关腹时(T3)及术后24 h(T4)4个时段分别采集产妇外周静脉血,采用血细胞自动分析仪检测产妇血红蛋白(Hb),采用凝固法检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(Fg)。对比两组产妇的止血效果、母婴结局及输血并发症发生率。结果两组分离全血量及术中出血量比较,差异无统计学意义(P>0.05)。整体分析发现:两组的PT及Fg比较,时间、组间、交互作用差异无统计学意义(P>0.05);两组的APTT、Hb比较,时间作用差异有统计学意义(P<0.05),组间、交互作用差异无统计学意义(P>0.05)。进一步两两比较,组内比较:两组APTT从长到短依次为T3、T4、T2、T1(P<0.05),两组Hb从高到低依次为T1、T2、T3、T4(P<0.05);组间比较:两组PT、APTT、Fg及Hb组间比较差异无统计学意义(P>0.05)。两组新生儿1 min Apgar评分、5 min Apgar评分及脐动脉血pH比较,差异无统计学意义(P>0.05)。回收组输血并发症发生率低于稀释组,差异有统计学意义(P<0.05)。结论稀释式和回收式自体血回输在凶险性前置胎盘产妇剖宫产中,止血效果、对婴儿结局的影响比较无明显差异,但回收式自体血回输并发症更少,安全性更高。Objective To investigate the effect of dilute and recovered autologous blood transfusions during a cesarean section in placenta previa and their effects on maternal and infant outcomes.Methods From January 2017 to February 2020,80 puerpera with dangerous placenta previa who underwent cesarean section in Department of Obstetrics and Gynecology of Changzhou Maternity and Child Health Hospital of Nanjing Medical University were selected.According to different methods of autologous blood transfusion,they were divided into dilution group(diluted autologous blood transfusion)and recovered group(recovered autologous blood transfusion).Maternal peripheral venous blood before the blood collection(T1),blood collection(T2),immediately after the closing abdomen(T3)and 24 h after surgery(T4)four times respectively were collected,and hemoglobin(Hb)of maternal was detected using automatic blood cell analyzer,prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(Fg)were detected by solidification method.The hemostatic effect,maternal and infant outcome and complication rate of two groups were compared.Results There were no significant differences in blood separation and intraoperative blood loss between two groups(P>0.05).The overall analysis showed that there were no significant differences in PT and Fg between two groups in terms of time,inter group and interaction(P>0.05).There were significant differences in APTT and Hb between two groups in terms of time(P<0.05),but there were no significant differences in APTT and Hb between two groups in inter group and interaction(P>0.05).Further pairwise comparison,intra group comparison:APTT in two groups was T3,T4,T2,T1 from long to short(P<0.05),and Hb from high to low was T1,T2,T3,T4(P<0.05).Comparison between groups:there were no significant differences in PT,APTT,Fg and Hb between two groups(P>0.05).There were no significant differences in one-minute Apgar score,five-minute Apgar score and umbilical artery blood pH between two groups(P>0.05).The incidence

关 键 词：自体血回输 凶险性前置胎盘 剖宫产 

分 类 号：R719.8[医药卫生—妇产科学]