基于多中心数据的回收式自体血回输在剖宫产术中的应用评价  

Evaluation the application of intra-operative cell salvage in cesarean section based on multicenter data

作　　者：吕斌 刘兴会 赵扬玉[2] 陈锰 陈代娟 胡晓静 肖熹荣 黄静[5] 王少帅 王乾华 刘淑香[8] 吴泉峰 洪燕语 赵磊[11] 翟闪闪[12] Lyu Bin;Liu Xinghui;Zhao Yangyu;Chen Meng;Chen Daijuan;Hu Xiaojing;Xiao Xirong;Huang Jing;Wang Shaoshuai;Wang Qianhua;Liu Shuxiang;Wu Quanfeng;Hong Yanyu;Zhao Lei;Zhai Shanshan(Department of Obstetrics and Gynecology,West China Second Hospital of Sichuan University,Chengdu 610041,China;Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Obstetrics and Gynecology,the Second Hospital of Hebei Medical University,Shijiazhuang 050004,China;Department of Obstetrics and Gynecology,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China;Department of Obstetrics and Gynecology,Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China;Department of Anesthesiology,the Fourth Hospital of Shijiazhuang,Shijiazhuang 050035,China;Department of Obstetrics,Xiamen Maternal and Child Health Hospital,Xiamen 361003,China;Department of Obstetrics,Women's Hospital,School of Medicine,Zhejiang University,Hangzhou 310006,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]四川大学华西第二医院妇产科,成都610041 [2]北京大学第三医院妇产科,100191 [3]重庆医科大学附属第一医院妇产科,400042 [4]复旦大学附属妇产科医院产科,上海200011 [5]河北医科大学第二医院妇产科,石家庄050004 [6]华中科技大学同济医学院附属同济医院妇产科,武汉430030 [7]华中科技大学同济医学院附属协和医院妇产科,武汉430022 [8]石家庄市第四医院麻醉科,050035 [9]厦门市妇幼保健院产科,361003 [10]浙江大学医学院附属妇产科医院产科,杭州310006 [11]郑州大学第一附属医院妇产科,450052 [12]郑州大学第三附属医院妇产科,450052

出　　处：《中华妇产科杂志》2021年第8期537-544,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2016YFC1000406);四川省科技计划(2018FZ0061)。

摘　　要：目的探讨回收式自体血回输(IOCS)技术在剖宫产术中应用的安全性、有效性及应用指征。方法收集2016年8月—2019年1月全国11家三级甲等医院剖宫产术中应用IOCS技术输血的产妇共1265例,根据剖宫产术中出血量分为<1500 ml组(796例)和≥1500 ml组(469例)。回顾性分析产妇及新生儿的一般临床资料、超声检查征象、围产期及产褥期指标;应用logistic多因素回归模型分析影响产妇术中出血量≥1500 ml的危险因素。结果(1)1265例应用IOCS技术输血的产妇总回收血量共848001 ml,回输血量共418649 ml,相当于23258 U红细胞悬液,极大地节约了医疗资源。(2)<1500 ml组和≥1500 ml组的中位术中出血量分别为800 ml(300~1453 ml)和2335 ml(1500~20000 ml)。两组产妇均无羊水栓塞、严重输血不良反应、休克、死亡发生。(3)多因素分析显示,年龄≥35岁(OR=1.5,95%CI为1.1~1.9)、产前血红蛋白水平<110 g/L(OR=1.7,95%CI为1.3~2.2)、子宫手术史(OR=1.8,95%CI为1.3~2.6)、前置胎盘(OR=1.9,95%CI为1.1~3.1)、胎盘植入(OR=2.6,95%CI为1.8~3.9)、胎盘内存在血池(OR=1.6,95%CI为1.1~2.3)、胎盘后肌壁异常(OR=1.8,95%CI为1.2~2.6)、胎盘凸向子宫前壁(OR=3.0,95%CI为1.3~7.0)是显著影响产妇术中出血量≥1500 ml的危险因素(P均<0.05)。结论IOCS技术输血在剖宫产术中应用相对安全、有效,节约了医疗资源,但需要严格规范其应用指征。Objective To investigate the safety,efficacy and application indication of intra-operative cell salvage(IOCS)in cesarean section.Methods A total of 1265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into<1500 ml group(796 cases)and≥1500 ml group(469 cases)according to the amount of blood loss during cesarean section.The general clinical data,ultrasonic imaging data,perinatal and puerperium indicators were analyzed retrospectively.The risk factors of intraoperative blood loss≥1500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results(1)A total of 848001 ml of blood was recovered and a total of 418649 ml of blood was transfused in 1265 pregnant women who received IOCS transfusions,which was equivalent to 23258 U red blood cell suspension,greatly saving medical resources.The intraoperative blood loss in<1500 ml group and≥1500 ml group was 800 ml(300-1453 ml)and 2335 ml(1500-20000 ml),respectively.No amniotic fluid embolism,severe adverse reactions,shock and death occurred in the two groups.(3)Multivariate regression analysis showed that age≥35 years(OR=1.5,95%CI:1.1-1.9),prenatal hemoglobin level<110 g/L(OR=1.7,95%CI:1.3-2.2),history of uterine surgery(OR=1.8,95%CI:1.3-2.6),placenta previa(OR=1.9,95%CI:1.1-3.1),placenta accreta(OR=2.6,95%CI:1.8-3.9),blood pool in the placenta(OR=1.6,95%CI:1.1-2.3),abnormal posterior placenta muscle wall(OR=1.8,95%CI:1.2-2.6),placenta projecting to the anterior uterine wall(OR=3.0,95%CI:1.3-7.0)were risk factors for blood loss≥1500 ml in obstetric transfusion using IOCS technique,with statistical significance(all P<0.05).Conclusion IOCS is safe and effective in cesarean section,which could save the medical resources and reduces medical expenses,however,it is necessary to strictly master the application indication.

关 键 词：剖宫产术 输血 自体 产后出血 

分 类 号：R719.8[医药卫生—妇产科学]