术中自体血回收用于产科手术的可行性研究

Research on feasibility of intraoperative cell salvage during obstetric surgery

目的通过定量分析血液中的甲胎蛋白及组织因子来判断产科术中回收血液的质量。方法 2014年10月-2015年4月本院妇产科收治的前置胎盘、胎盘早剥及胎盘植入拟行剖宫产患者10例,分别于右颈内静脉穿刺置管即刻(T1)、切皮(T2)、胎盘剥离即刻(T3)、胎盘剥离5 min(T4)及30 min(T5)后各个时间点抽取中心静脉血液,并留取经自体血回收机洗涤后的血液(T6)及白细胞过滤器过滤后血液(T7)。随后对收集的标本用ELISA法对血清甲胎蛋白及血浆组织因子进行定量分析。结果血液中的甲胎蛋白经血液回收机洗涤后显著降低,T1、T2、T3、T4、T5各时刻的血清甲胎蛋白比较差异不具统计学意义(P>0.05),分别与T6、T7时刻的甲胎蛋白比较,差异具统计学意义(P<0.01),T6与T7时刻的甲胎蛋白比较,差异不具统计学意义(P>0.05)。各时刻的血浆组织因子比较差异不具统计学意义(P>0.05)。结论产科术中经自体血回收机回收洗涤的血液,联合使用白细胞过滤器回输体内理论上可行。

Objective To evaluate the quality of the intraoperative cell salvage during obstetric surgery by quantitative analysis of the alpha-fetoprotein（ AFP） and tissue factor（ TF） in the blood. Methods From the 10 cases of planned Cesarean section with placenta previa,placental abruption and placenta accreta admitted in the Department of Obstetrics ＆ Gynecology in our hospital from October 2014 to April 2015,central venous blood was in the following time： immediate right jugular venipuncture and catheterization（ T1）,skin incision（ T2）,immediate placenta separation（ T3）,5minutes after placenta separation（ T4）,and 30 minutes after placenta separation（ T5）. Specimens were extracted from washing salvaged blood（ T6） and the filtered blood（ T7）. Then,the collected samples were quantitatively analyzed by ELISA test on serum AFP and plasma TF. Results Serum AFP significantlydecreased in the washed salvaged blood. The differences among the serum AFP at T1,T2,T3,T4 and T5 showed no statistical significance（ P 〉 0. 05）,while there was significant difference between the serum AFP at T1,T2,T3,T4,T5 respectively with the serum AFP at T6 or T7（ P 〈 0. 001）. The differences among the serum AFP at T6 and T7 showed no statistical significance（ P 〉 0. 05）. There was no significant difference among the plasma TF at each time point（ P 〉 0. 05）. ConclusionI t is theoretically possible to re-transfuse washed salvaged blood which was added to leucocyte depletion filters of the cell salvage circuit during obstetric Surgery.