剖宫产术中大出血产妇应用回收式自体输血对血流动力学、凝血功能及安全性的影响  

Effect of Intraoperative Cell Salvage on Hemodynamics,Coagulation Function and Safety of in Parturients with Massive Hemorrhage During Cesarean Section

作　　者：张薇 程星星 卢丽 ZHANG Wei;CHENG Xing-xing;LU Li(Department of Obstetrics and Gynecology,Qinhuangdao Military Industry Hospital,Qinhuangdao,Hebei 066001,China)

机构地区：[1]秦皇岛军工医院妇产科,河北秦皇岛066001

出　　处：《临床误诊误治》2022年第9期75-79,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的观察回收式自体输血(ICS)对剖宫产术中大出血产妇血流动力学、凝血功能及安全性的影响。方法选取2020年2月—2021年4月行ICS的剖宫产术中大出血产妇42例作为观察组,另将同期采用异体输血的剖宫产术中大出血产妇40例作为对照组。比较2组输血前及输血后血流动力学指标[血氧饱和度(SpO_(2))及心率(HR)],凝血功能指标[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)]及肝功能指标[天冬氨酸转氨酶(AST)、谷氨酸转氨酶(ALT)、碱性磷酸酶(ALP)],以及输血反应和新生儿情况[新生儿窒息率和5 min Apgar评分]。结果输血后2组SpO_(2)升高、HR降低,且观察组SpO_(2)及HR均高于对照组(P<0.01)。输血后2组PT、APTT及TT缩短,FIB升高,且观察组变化幅度优于对照组(P<0.01)。2组输血前、输血后组间及输血前后组内AST、ALT、ALP比较差异均无统计学意义(P>0.05)。观察组输血反应发生率低于对照组(P<0.05)。观察组新生儿窒息率低于对照组,新生儿5 min Apgar评分高于对照组(P<0.05,P<0.01)。结论与异体输血相比,ICS能更好维持剖宫产术中大出血产妇血流动力学稳定,促使机体凝血功能恢复,对肝功能无损伤,安全性高,且能降低产妇不良妊娠结局发生率。Objective To observe the effect of intraoperative cell salvage(ICS)on hemodynamics,coagulation function and safety of parturients with massive hemorrhage during cesarean section(C-section).Methods Forty-two parturients with massive hemorrhage during C-section who underwent ICS from February 2020 to April 2021 were selected as the observation group,and 40 parturients with massive hemorrhage during C-section who received allogeneic blood transfusion during the same period were selected as the control group.Hemodynamic indexes[blood oxygen saturation(SpO_(2))and heart rate(HR)]before and after blood transfusion,coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)]and liver function indicators[aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP)],as well as transfusion reaction and status of neonates[neonatal asphyxia rate and 5-min Apgar score]were compared between the two groups.Results SpO_(2) increased and HR decreased in two groups after blood transfusion,and the SpO_(2) and HR in observation group were higher than those in control group(P<0.01).After blood transfusion,PT,APTT and TT were shortened,while FIB was increased in two groups,and the changes in observation group were better than those in control group(P<0.01).There was no significant difference in AST,ALT and ALP in intergroup comparison before and after blood transfusion,and in intragroup comparison before and after blood transfusion(P>0.05).The incidence of blood transfusion reaction in observation group was lower than that in control group(P<0.05).The neonatal asphyxia rate in observation group was lower than that in control group,while the 5 min Apgar score of the neonates in observation group was higher than that in control group(P<0.05,P<0.01).Conclusion Compared with allogeneic blood transfusion,ICS can better maintain the hemodynamic stability of parturients with massive hemorrhage during C-section,promote the recovery of the body's coa

关 键 词：产后出血 剖宫产术 输血 自体 血氧饱和度 凝血酶原时间 碱性磷酸酶 输血反应 新生儿窒息 

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