ANH自体输血在完全性前置胎盘合并胎盘植入剖宫产术中的应用

Application of Acute Normovolemic Hemodilution(ANH) Autohemotransfusion in Complete Placenta Previa Merged Placenta Increta Cesarean Section

目的:研究急性等容血液稀释(ANH)自体输血在完全性前置胎盘合并胎盘植入剖宫产术中的应用价值。方法:选择2012年1月~2015年12月在我院进行诊治的完全性前置胎盘合并胎盘植入患者80例,随机分为三组,对照组(n=26)进行常规处理,ANH组(n=27)进行急性等容血液稀释,AHH(急性高容血液稀释)组(n=27)进行急性高容血液稀释。比较三组产妇的体重、年龄、手术时间、术中出血量、输注异体血例数,ANH组和AHH组血液稀释前后和三组产妇术后的动脉血气分析值、术后2 h血常规,三组新生儿娩出后1min、5min Apgar评分及脐动脉血血气分析值。结果:血液稀释后,两组的血红蛋白、红细胞比容和碱剩余均较血液稀释前明显降低(P<0.05),两组血气分析无明显差异(P>0.05);ANH组输注异体血的比例明显低于AHH组和对照组(P<0.05),剖宫产术后2h,ANH组的血红蛋白、红细胞比容和血小板均明显高于AHH组和对照组(P<0.05);三组新生儿的血红蛋白、红细胞比容、碱剩余、血乳酸和Apgar评分均无明显差异(P>0.05)。结论:ANH自体输血能减少异体血的输注和产妇剖宫术中红细胞的丢失,节约临床用血,对产妇和新生儿的影响较小。

Objective： To investigate the application value of acute normovolemic hemodilution （ANH） autohemotransfusion in complete placenta previa merged placenta increta cesarean section. Methods： 80 cases of patients with complete placenta previa merged placenta increta cesarean section fi＇om January 2012 to December 2015 were selected and divided into the control group （n=26, Conventional treatment）, ANH group （n=27, acute normovolemic hemodilution） and AHH group （n=27, acute hypervolemic hemodilution）. The body weight, age, operation time, intraoperative blood loss, blood infusion cases,arterial blood gas analysis values, 2 h after routine blood, apgar score and umbilical artery blood gas analysis values 1 min, 5 min after partum of three groups were compared. Results： After the blood dilution, the hemoglobin, red blood cell volume and residual alkali of ANH and AHH group were significantly lower than before treatment （P〈0.05）, no significant difference was found in the blood gas analysis between two groups（P 0.05）. The percentage of allogeneic blood transfusion of ANH group was significantly lower than those of the AHH group and control group （P〈0.05）; at 2 h after cesarean section, the hemoglobin, red blood cell volume and platelets of the ANH group were significantly higher than those of the AHH group and control group （P〈0.05）; no significant difference was found in the hemoglobin, red blood cell volume, residual alkali, blood lactic acid and apgar score between three groups （P〈0.05）. Conclusions： ANH autohemotransfusion could reduce the allogeneic blood infusion and the loss of red blood ceils in cesarean section, save the clinical use, and has little effect on the maternal and newborn.