两种不同输血方式对行剖宫产术产妇凝血功能和细胞免疫功能的影响  

The effect of two different blood transfusion methods on coagulation function of women undergoing cesarean section and the influence of cellular immune function

作　　者：陈皆锋[1] 潘郑斌 丁洁岚[1] 柯燕君 高利卿 CHEN Jie-feng;PAN Zheng-bin;DING Jie-lan;KE Yan-jun;GAO Li-qing(Department of Anesthesiology,Shaoxing Maternal and Child Health Hospital,Shaoxing,Zhejiang 312000,China)

机构地区：[1]绍兴市妇幼保健院麻醉科,浙江绍兴312000

出　　处：《中国妇幼保健》2023年第8期1359-1364,共6页Maternal and Child Health Care of China

基　　金：浙江省绍兴市科技计划项目(2018C30041);浙江省绍兴市妇幼保健院医学重点学科建设资金资助(绍市妇保2021-46号)。

摘　　要：目的比较回收式自体输血和异体成分输血对行剖宫产术产妇凝血功能和细胞免疫功能的影响。方法选取2019年2月—2021年1月在绍兴市妇幼保健院行剖宫产手术的产妇50例为研究对象,根据术中输血方式分为回收式自体输血组(观察组)和异体输血组(对照组),每组各25例。比较两组产妇术前Hb、出血量、输血量(自体血或异体血)、不同时点凝血功能指标及细胞免疫功能水平。结果两组产妇一般情况、术前Hb水平[观察组(112.1±13.2)g/L,对照组(115.4±10.8)g/L]、出血量[观察组(1129.0±110.0)ml,对照组(1094.0±132.0)ml]及输血量[观察组(762.0±54.0)ml,对照组(775.0±67.0)ml]比较,差异均无统计学意义(t=0.967、1.019及0.755,均P>0.05)。与对照组比较,观察组产妇凝血酶原时间(PT)、凝血反应时间(R时间)、纤溶指数(LY30)在T2时缩短,凝固角(α角)在T3时增大,血栓最大幅度(MA值)在T2时增大,CD3^(+)水平在T3~4时升高,CD4^(+)、CD4^(+)/CD8^(+)比值、自然杀伤细胞(NK细胞)水平在T2~3时升高,CD8^(+)水平在T2~4时升高,差异均有统计学意义(均P<0.05)。与T1比较,两组产妇PT、活化部分凝血活酶时间(APTT)在T2~3时延长,纤维蛋白原(FIB)在T2~4时降低,凝血酶时间(TT)在T2时延长,R时间在T2时延长,MA值在T2~3时降低,α角T3时降低;观察组CD3^(+)水平在T2~3时降低,CD4^(+)水平在T2时降低,NK细胞水平在T3~4时降低,凝血形成时间(K时间)在T3时延长;对照组TT和R时间在T3时延长,CD3^(+)水平在T3~4时降低,CD4^(+)水平在T2~3时降低,CD8^(+)与NK细胞水平在T2~4时降低,CD4^(+)/CD8^(+)比值在T2时降低,差异均有统计学意义(均P<0.05)。结论与异体成分输血相比,回收式自体输血产妇凝血功能和细胞免疫功能的影响较小,是一种安全、有效的输血方式。Objective To compare the effects of recovered autotransfusion and allogeneic component transfusion on coagulation function and cellular immunity of parturients undergoing cesarean section.Methods Fifty women receiving cesarean section in Shaoxing Maternal and Child Health Hospital from February 2019 to January 2021 were selected as the research subjects.According to the way of intraoperative blood transfusion,they were divided into recovery autotransfusion group(observation group)and allogeneic blood transfusion group(control group),25 cases in each group.Preoperative Hb,blood loss,blood transfusion(autologous blood or allogeneic blood)and coagulation function at different time points were compared between the two groups index and cellular immune function level.Results The general conditions and preoperative Hb levels of parities in the two groups[observation group(112.1±13.2)g/L,control group(115.4±10.8)g/L],blood loss[observation group(1129.0±110.0)ml,control group(1094.0±132.0)ml],blood transfusion[observation group(762.0±54.0)ml,control group(775.0±67.0)ml],the differences were not statistically significant(t=0.967,1.019 and 0.755,all P>0.05).Compared with the control group,the prothrombin time(PT),coagulation response time(R time)and fibrinolytic index(LY30)were shortened at T2,the coagulation Angle(αAngle)was increased at T3,and the thrombus was the largest(MA Value)increased at T2,CD3^(+)level increased at T3-4,CD4^(+),CD4^(+)/CD8^(+)ratio and NK cell level increased at T2-3.CD8^(+)levels increased at T2-4,and the differences were statistically significant(all P<0.05).Compared with T1,PT and activated partial thromboplastin time(APTT)were in the two groups.It is prolonged at T2-3,fibrinogen(FIB)is decreased at T2-4,thrombin time(TT)is prolonged at T2,R time is prolonged at T2,and MA value is prolonged at T2-3.Lower,lower when cutting Angle T3;In the observation group,CD3^(+)level decreased at T2-3,CD4^(+)level decreased at T2,NK cell level decreased at T3-4,and coagulation formation time(K time)leng

关 键 词：回收式自体输血 剖宫产术 血栓弹力图 免疫功能 

分 类 号：R457.1[医药卫生—治疗学]