术中急性等容稀释性自体输血联合空气波压力治疗对剖宫产术后产妇下肢深静脉血栓形成及CD40/CD40L系统、血浆D-二聚体、高敏C反应蛋白水平的影响  

Effects of intraoperative acute normovolemic hemodilution with autotransfusion combined with air wave pressure therapy on lower extremity deep venous thrombosis formation,CD40/CD40L system,and plasma D-dimer and high-sensitivity C-reactive protein levels in puerperae after cesarean section

作　　者：张丽武[1] 覃纬 王丽[1] ZHANG Li-wu;QIN Wei;WANG Li(Department of Obstetrics,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541002,China)

机构地区：[1]广西壮族自治区南溪山医院产科,桂林市541002

出　　处：《广西医学》2022年第8期838-842,共5页Guangxi Medical Journal

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2017074)。

摘　　要：目的探讨术中急性等容稀释(ANH)自体输血联合空气波压力治疗对剖宫产术后产妇下肢深静脉血栓(LEDVT)形成及CD40/CD40L系统、血浆D-二聚体、高敏C反应蛋白(hs-CRP)水平的影响。方法将300例行剖宫产术的产妇随机分成对照组、稀释组和联合治疗组,各100例。对照组产妇术中采用贮存式自体输血,稀释组和联合治疗组产妇术中均采用ANH自体输血,联合治疗组在术后当天开始使用空气波压力治疗仪治疗。比较3组产妇术后2周LEDVT的发生率;比较3组产妇手术当天及术后第3天的血浆D-二聚体、hs-CRP、可溶性CD40配体(sCD40L)水平,以及外周血单个核细胞(PBMC)的CD40相对表达水平。结果联合治疗组的LEDVT发生率低于对照组(P<0.05),而稀释组和联合治疗组的LEDVT发生率差异无统计学意义(P>0.05)。术后第3天,3组产妇血浆D-二聚体、hs-CRP、sCD40L水平及PBMC的CD40相对表达水平由高到低均为对照组、稀释组、联合治疗组(均P<0.05),且联合治疗组产妇血浆D-二聚体、hs-CRP、sCD40L水平及PBMC的CD40相对表达水平,以及稀释组血浆D-二聚体、sCD40L水平及PBMC的CD40相对表达水平均低于手术当天(均P<0.05)。结论术中ANH自体输血联合空气波压力治疗能有效降低剖宫产术后产妇LEDVT的发生率,其机制可能与其抑制CD40/CD40L系统的活性并降低血浆D-二聚体、hs-CRP的水平有关。Objective To investigate the effects of intraoperative acute normovolemic hemodilution(ANH)with autotransfusion combined with air wave pressure therapy on lower extremity deep venous thrombosis(LEDVT)formation,CD40/CD40L system,and plasma D-Dimer and high-sensitivity C-reactive protein(hs-CRP)levels in puerperae after cesarean section.Methods A total of 300 puerperae undergoing cesarean section were randomly divided into control group,dilution group and combined therapy group,with 100 cases in each group.Puerperae in the control group underwent intraoperative transfusion with autologous blood which had been donated preoperatively,puerperae in the dilution and combined therapy groups underwent ANH with autotransfusion during the operation,and the combined therapy group initiated the treatment with an air wave pressure therapy apparatus on the day of the operation.The incidence rate of LEDVT two weeks after the operation was compared among the three groups.The plasma levels of D-dimer,hs-CRP,and soluble CD40 ligand(sCD40L),and the relative expression level of CD40 in peripheral blood mononuclear cell(PBMC)were compared among the three groups on the day of the operation and the 3rd day after the operation.Results The incidence rate of LEDVT in the combined therapy groups was lower than that in the control group(P<0.05),but there was no statistically significant difference in the incidence rate of LEDVT between the dilution group and the combined therapy group(P>0.05).On the 3rd day after the operation,the plasma levels of D-dimer,hs-CRP,and sCD40L,as well as the relative expression level of CD40 in PBMC decreased in the control group,dilution group and combined therapy group successively(all P<0.05);moreover,the plasma levels of D-dimer,hs-CRP,and sCD40L,and the relative expression level of CD40 in PBMC in the combined therapy group were declined,together with the lower plasma levels of D-dimer and sCD40L and the lower relative expression level of CD40 in PBMC in the dilution group,in comparison with those on the da

关 键 词：剖宫产 下肢深静脉血栓 急性等容稀释自体输血 空气波压力治疗 CD40/CD40L D-二聚体 高敏C反应蛋白 

分 类 号：R719.8[医药卫生—妇产科学] R457.1[医药卫生—临床医学]