区域性孕产妇救治中心围产期输血情况的调查  

Investigation on the condition of perinatal blood transfusion in regional maternal treatment center

作　　者：周燕 仲晓玲[2] 卢先艳[1] 王志群[1] 戴毅敏[1] ZHOU Yan;ZHONG Xiaoling;LU Xianyan;WANG Zhiqun;DAI Yimin(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Jiangsu Nanjing 210008,China;Department of Blood Transfusion,Nanjing Drum Tower Hospital,Nanjing University Medical School,Jiangsu Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,江苏南京210008 [2]南京大学医学院附属鼓楼医院输血科,江苏南京210008

出　　处：《中国妇幼健康研究》2021年第9期1298-1303,共6页Chinese Journal of Woman and Child Health Research

基　　金：江苏省妇幼健康科研项目(F201742)。

摘　　要：目的通过调查区域性高危孕产妇救治中心的围产期输血情况,为今后指导产科合理用血的管理工作提供依据。方法回顾性调查2013年1月至2019年12月在南京大学医学院附属鼓楼医院分娩并至少输注红细胞(RBC)的孕产妇804例,分析导致围产期输注红细胞的主要病种分布,结合各病种输血率、输血构成比、输血量和输血时机,评价大量输血者成分输血情况,分析不同分娩方式与出院前血红蛋白(Hb)水平的关系。结果2013年1月至2019年12月期间,该院分娩总数44874人,输注RBC者804例(占1.8%)。(1)需要输血治疗患者人数最多的前3个病种是产后出血、前置胎盘和胎盘植入疾病,占输血总人数的53.5%;单病种输血率最高的3个病种是羊水栓塞(100.0%)、妊娠期急性脂肪肝(61.1%)和胎盘植入疾病(44.2%)。(2)分娩前7天内需要输血者共180人(22.4%),以妊娠合并血液系统疾病和自身免疫病等内科疾病为主;产后24h内需要输血603人(75.0%),以羊水栓塞、胎盘植入疾病、胎盘早剥和产后出血等产科危急重症为主;而产后24h后仍需输血者144人(17.9%),以HELLP综合征、妊娠期急性脂肪肝和自身免疫病为主。(3)需要大量输血的前3位病种是羊水栓塞、HELLP综合征和胎盘植入疾病,其中RBC输注量≥4IU者364例(45.2%),≥10IU者90例(11.2%),RBC输注量≥4IU和≥10IU的孕产妇出院前Hb分别为(95.0±16.9)g/L和(97.2±18.1)g/L,差异无统计学意义(t=-1.101,P>0.05);RBC输注量≥10IU的90例孕产妇中,输注RBC∶血浆∶血小板比为1.3∶1.0∶1.0。(4)804例输血患者中,774人(96.3%)出院前Hb≥70g/L,其剖宫产和阴道分娩的比例差异无统计学意义(χ^(2)=0.073,P>0.05),而在出院前Hb≥100g/L患者中剖宫产和阴道分娩分别占43.5%和14.8%,差异有统计学意义(χ^(2)=62.733,P<0.01);出院前Hb≥100g/L患者中216例(83.1%)的输血原因是急性大出血。结论导致围产期输血的主要病种是前置胎盘、胎盘�Objective To provide reference for guiding the management of rational blood transfusion in department of obstetrics in the future by investigating the condition of perinatal blood transfusion in regional high-risk maternal treatment center.Methods We retrospectively investigated 804 patients who delivered and at least received red blood cells(RBC)transfusion in the Nanjing Drum Tower Hospital,Nanjing University Medical School between January 2013 and December 2019.The distribution of main diseases leading to perinatal red blood cells transfusion was analyzed,and the blood transfusion rate of each disease,composition ratio,volume and timing of transfusion were combined to evaluate the situation of component transfusion in patients with massive blood transfusion,and the relationship between different delivery modes and hemoglobin(Hb)level before discharge was analyzed.Results From January 2013 to December 2019,the number of deliveries was 44874 in this hospital,and 804 patients received RBC transfusion(accounting for 1.8%).(1)The top 3 diseases of the largest numbers of patients needing blood transfusion treatment were postpartum hemorrhage,placenta previa and placenta accreta disease,accounting for 53.5%of the total number of patients with blood transfusion.The top 3 diseases with the highest blood transfusion rates were amniotic fluid embolism(100.0%),acute fatty liver disease of pregnancy(61.1%)and placenta accreta disease(44.2%).(2)A total of 180 patients(22.4%)needed blood transfusion within 7 days before delivery,and the main diseases were hematological diseases and autoimmune diseases.603 patients(75.0%)needed blood transfusion within 24 h after delivery,and the main diseases were the obstetric critical illnesses such as amniotic fluid embolism,placenta accreta disease,placental abruption and postpartum hemorrhage,etc.However,144 patients(17.9%)still needed blood transfusion after 24 h after delivery,and the main diseases were HELLP syndrome,acute fatty liver disease of pregnancy and autoimmune diseases.(3)T

关 键 词：输血 大量输血 患者血源管理 产后出血 胎盘植入疾病 

分 类 号：R714.7[医药卫生—妇产科学]