回收式自体输血在前置胎盘剖宫产术中应用价值的Meta分析  

Intraoperative cell salvage in cesarean delivery of women with placenta previa:a meta-analysis

作　　者：宋斌 王丹 严小 丽阎萍 SONG Bin;WANG Dan;YAN Xiaoli;YAN Ping(Department of Gynecology and Obstetrics,First Affiliated Hospital(Army Medical University),Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院妇产科,重庆400038

出　　处：《中国输血杂志》2024年第1期111-119,共9页Chinese Journal of Blood Transfusion

基　　金：重庆市科技局项目(cstc2019jscx-msxmX0165)。

摘　　要：目的荟萃分析回收式自体输血(IOCS)在前置胎盘剖宫产术中的安全性和有效性。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library of clinical trials、中国知网(CNKI)及万方数据知识服务平台。检索时限设定为建库至2022年12月。采用R 4.1.2与Stata 12.0软件计算IOCS组和异体输血(ABT)组之间的标准化均数差(SMD)或相对危险度(RR)及95%置信区间(CI)和预测区间(PI)。结果本次Meta分析共纳入5项随机对照试验和10项回顾性队列研究。队列研究的合并结果显示,与ABT组相比,接受IOCS的前置胎盘孕产妇术后血红蛋白(Hb)浓度(SMD=0.626,95%CI:0.103~1.149;95%PI:-1.320~2.572)与红细胞压积较高(SMD=0.617,95%CI:0.130~1.104;95%PI:-1.084~2.317)。在随机对照试验中,接受IOCS的前置胎盘孕产妇发生不良事件的风险比ABT组低72.7%(RR=0.273,95%CI:0.082~0.904)。IOCS组和ABT组术后凝血酶原时间(PT)、活化凝血酶原时间(APTT)、纤维蛋白原(Fib)浓度、血尿素氮(BUN)和肌酐(Cr)差异均无无统计学意义。结论接受IOCS的前置胎盘孕产妇术后Hb浓度和Hct均高于接受ABT的妇女。IOCS对术后凝血参数和肾功能参数无显著影响。在接受剖宫产术的前置胎盘孕产妇中,IOCS与较低的输血相关不良事件发生风险有关。Objective To systematically evaluate the safety and efficacy of intraoperative cell salvage(IOCS)for placenta previa women undergoing cesarean section.Methods The PubMed,Web of Science,Embase,the Cochrane Library of clinical trials,China National Knowledge Infrastructure(CNKI)and Wan Fang databases were searched from inception to September 2022.The standardized mean differences(SMDs)or relative risk(RR)and 95%confidence intervals(CIs)and prediction intervals(PIs)regarding the comparison between the IOCS and allogeneic blood transfusion(ABT)groups were analyzed using R software Version 4.1.2 and Stata Version 12.0.Results Five RCTs and ten retrospective cohort studies were included in this meta-analysis.Analysis of cohort studies showed that compared with the ABT group,women with placenta previa who underwent IOCS had generally higher postoperative hemoglobin(Hb)(SMD,0.626;95%CI:0.103 to 1.149;95%PI:-1.320 to 2.572)and hematocrit(Hct)(SMD,0.617;95%CI:0.130 to 1.104;95%PI:-1.084 to 2.317)levels.In RCTs,we observed that placenta previa women undergoing IOCS were almost 72.7%less likely to suffer from adverse events AEs than the ABT group(RR,0.273;95%CI,0.082 to 0.904).The difference in postoperative prothrombin time(PT),activated prothrombin time(APTT),fibrinogen(Fib)concentration,blood urea nitrogen(BUN)and creatinine(Cr)between the IOCS and ABT group did not reach statistical significance.Conclusion Women with placenta previa who undergo IOCS have higher postoperative Hb and Hct concentrations compared to those treated with ABT.IOCS has no major effects on postoperative coagulation parameters and renal function parameters.IOCS is associated with a significantly lower risk of transfusion-related AEs among women undergoing cesarean section.

关 键 词：回收式自体输血 剖宫产 前置胎盘 META分析 异体输血 

分 类 号：R457.1[医药卫生—治疗学] R714.4[医药卫生—临床医学]