产前贮存式自体备血的可行性及对母儿安全影响的研究

Feasibility and safety of preoperative autologous blood donation for pregnant patients

目的术前自体备血(preoperative autologous blood donation,PABD)可减少对异体血源的需求,但备血时可引起孕妇短时间大量失血,对胎儿及孕妇的安全性尚未充分评估。文章探讨PABD的可行性及对母儿安全性的影响。方法设置符合PABD的纳入标准,募集2013年1月至2013年12月间在南京大学医学院附属鼓楼医院定期产检并拟在本院住院分娩的孕妇,在知情同意基础上行PABD。参照2013年美国加州围产期出血高危分类临床标准,将PABD孕妇分为低危组、中危组及高危组。观察孕妇采血前后血常规、血压、心率、末梢血氧饱和度及其他不良反应变化情况,电子胎心监护观察胎心变化,分析孕妇行PABD的安全性,并评估各组产时出血量、自体血回输情况及分娩结局。结果 92例接受PABD的孕妇共采血115例次。低危组、中危组和高危组产前备血量中位数分别为300、300及400 m L。115例次孕妇采血后5 min舒张压较采血开始时平均下降3.4 mm Hg,差异有统计学意义(P<0.05);采血结束时反映监测生命征变化的参数差异无统计学意义(P>0.05);胎心监护全部为反应型。PABD孕妇单次采血后血红蛋白和红细胞压积(hematocrit,HCT)较采血前平均降低5.4%和2.1%,差异均有统计学意义(P<0.05),分娩前均恢复至采血前水平。2次行PABD的孕妇血红蛋白和HCT变化与单次采血类似,但第2次采血后血红蛋白、HCT与采血前相比差异无统计学意义(P>0.05)。所有孕妇分娩后无新生儿窒息和围产儿死亡。结论 PABD可为产妇及时提供自体全血。在严格管理下,有指征地使用PABD技术具有合理性和安全性。

Objective Preoperative autologous blood donation （ PABD） may reduce the need for allogeneic blood , but it may also cause a short massive blood loss in pregnant women , and its fetal and maternal safety has to be adequately assessed .This study was to evaluate the feasibility and safety of PABD for pregnant women and their fetuses . Methods A prospective observational study was conducted among the women who met the inclusion criteria and gave birth in Nanjing Drum Tower Hospital between January and December 2013 .According to the clinical validation of risk stratification criteria for peripartum hemorrhage of California 2013 , the ca-ses were classified into a low-, a medium-, and a high-risk group.Data on blood donation procedures , obstetric outcomes, and blood transfusions were collected after delivery for analysis . Results Totally, 92 pregnant women accomplished 115 blood donations .The median volumes of the donated blood were 300, 300, and 400 mL in the low-, medium-, and high-risk groups, respectively （ P〉0.001）.There were no significant changes in HR , SBP and SpO2 during the blood donation procedures （P〉0.05） except for the fall of diastolic blood pressure by an average of 3.4 mmHg （P0.05）, which were similar to those in the cases who donated twice , with no significant differences before and after the donation （P〉0.05）. Homologous blood transfusion was performed for 5 cases （17.9%） in the high-risk group, with the volume of blood loss 〉2000 mL in all the cases.All the newborns survived without asphyxia and there was no perinatal death . Conclusion PABD can provide timely autologous whole blood donation for pregnant women .Under strict management , PABD is feasible and safe for pregnant patients who are at a high risk for massive blood loss during delivery or have a rare type of blood no readily available .