前置胎盘患者自体血浆分离联合术中自体血回收的可行性

Feasibility of autologous plasmapheresis combined with intraoperative blood salvage during cesarean section in patients with placenta previa

目的观察自体血浆分离联合术中自体血回收应用于产科前置胎盘患者的安全性和有效性。方法选择择期行剖宫产术的前置胎盘患者60例,按随机数字表法分为3组,每组20例。Ⅰ组:术前自体血浆分离联合术中自体血回收组;Ⅱ组:单纯术中自体血回收组;Ⅲ组:按需输注异体血。分别于入手术室后(T_1)、采血后10min(T_2)、自体血回输前10 min(T_3)、回输后10min(T_4)、术后6h(T_5)以及术后24h(T_6)抽取静脉血测定Hb、Hct、Plt、PT、APTT、FIB;记录3组血流动力学变化和胎心、新生儿评分、脐动脉血气分析结果以及术中失血量、输液、输血量。结果3组血流动力学变化和胎心、新生儿评分、脐动脉血气分析结果的差异均无统计学意义(均P>0.05);T4、T5时点,Ⅰ组的Plt升高与Ⅱ、Ⅲ组的差异有统计学意义(P<0.05);Ⅰ组的PT在T4时点恢复正常,与Ⅱ、Ⅲ组的差异有统计学意义(P<0.05);Ⅱ、Ⅲ组血浆输入与Ⅰ组的差异有统计学意义(P<0.05);Ⅲ组红细胞输入与Ⅰ、Ⅱ组的差异有统计学意义(P<0.05)。结论术前自体血浆分离联合术中自体血回收或单纯术中自体血回收用于在产科前置胎盘患者安全可行,可减少异体血的输注,节约血源。

Objective To evaluate the efficacy and safety of autologous plasmapheresis combined with intraoperative blood salvage during cesarean section in patients with placenta previa. Methods Sixty patients with placenta previa scheduled for elective cesarean section, were randomly divided into three groups with 20 cases in each group. In group I, blood was with-drawn before anesthesia, to sequester the autologous plasma for re- infusion. An autotransfusion device was used to col ect and re- infuse autologous RBC during the course of the operation in both groups I and II, while an al ogenic blood transfusion was conducted in group III as necessary. Hemoglobin（Hb）, hematocrit （Hct）, platelet count （Plt）, prothrombin time （PT）, activated par-tial thromboplastin （aPTT）, fibrinogen （FIB） were detected at time points of entering operation room （T1）, 10min after col ecting blood（T2）, 10 min before autologous re- infusing（T3）, 10 min after autologous blood re- infusing（T4）, 6h after operation（T5） and 24h after operation （T6）. Hemodynamic changes, fetal heart rate, Apger score, umbilical cord artery blood gas analysis, volumes of blood loss and blood transfusion of three groups were documented and compared. Results There were no significant differ-ences in hemodynamic changes, fetal heart rate, Apger score and umbilical cord artery blood gas analysis among three groups. The increase of Plt level of Group I was significantly different from Group II and Group III at T4 and T5 （P〈0.05）;PT level change in Group I had significant differences compared with Group II and Group III at T4 （P〈0.05）. The volumes of plasma transfusion in Group II and Group III had significant differences compared with Group I （P〈0.05）. The volumes of packed red blood cells （RBCs） transfusion in Group III had significant differences compared with Group I and Group II （P〈0.05）. Conclusion Autolo-gous plasmapheresis combined with intraoperative blood salvage is safe and feasible, which can reduce the al ogeneic blood transfusion and save the blood.