回收式自体输血对剖宫产产妇的影响

Effect and safety of intraoperative cell salvage during cesarean section

目的评估剖宫产术中应用同收式自体输血（intraoperativecellsalvage，ICS）的安全性和有效性。方法本研究为病例对照研究。研究对象为2014年1月至2016年12月在复旦大学附属妇产科医院行剖宫产术，术中行ICS的患者60例（自体血组），并按照年龄、孕周、妊娠合并症（胎盘植入、前置胎盘、瘢痕子宫、妊娠合并子宫肌瘤、贫血）及出血量与自体血组相匹配，选择仅输入异体廊的患者60例作为列照（库血组）。比较2组患者输血反应的发生率、手术前后主要血常规指标、手术前后体温、术后恢复指标及用血费用。采用t检验、秩和检验或x2俭验对数据进行统计学分析。结果（1）2组年龄、孕周、双胎、妊娠合并症、术前体温、出血量和输血总量差异均无统计学意义。（2）自体血组回输量为385（161～583）ml，其中15例（20．0％）又输注了去白红细胞悬液、新鲜冰冻血浆及冷沉淀，2例（3．3％）输注了去白红细胞悬液和新鲜冰冻血浆。2组输血费用、人均新鲜冰冻血浆和冷沉淀输注量差异均无统计学意义，但自体血组输注去白红细胞悬液的量少于库血组[M（P25～P75），分别为1．9（1．5～4．5）与4．1（2．8～6．2）U，Z=-2．800，P-O．0051。（3）2组患者术前血常规及凝血常规指标均兀统计学意义。2组术后白细胞计数均高于术前。库血组术后的白细胞计数高于自体血组，红细胞和血红蛋白分别低于本组术前和自体fIfL组（P值均〈O．05）。（4）2组均未发生羊水栓塞。库血组共8例（13．3％）发生输血反应。口体血组仅1例（1．7％）发生皮疹。2组输血反应发生率差异有统计学意义（x2=5．886，P=0．016）。（5）2组患者术前体温、术后3d内最高体温及伤口愈合情况差异无统计学意义。自体血组术后住院时间短于库血组[（4．7±1．1）与（6．3±118）d，t=3．341，P〈0．05]。结论ICS用于有大出血风险的产妇的剖宫产术是安全和有效的。

Objective To assess the safety and effect of intraoperative cell salvage （ICS） during cesarean section. Methods This was a case control study in which 60 gravidas who received ICS （ICS group） and 60 gravidas who received allogenic transfusion （control group） during caesarean section in Obstetrics and Gynecology Hospital of Fudan University during January 2014 to December 2016 were enrolled. Subjects in the two groups were matched in age, gestational age, gestational complications （placenta increta, placenta previa, scarred uterine, leiomyomas and anemia） and hemorrhagic volume during cesarean section. Several indicators including complications of transfusion, postoperative recovery, expense of transfusion, as well as the complete blood count and body temperature before and after operation were compared between the two groups. T, rank sum or Chi square test was used for statistical analysis. Results （1） No significant difference in age, gestational age, twin gestation, complications, preoperative body temperature, or the volume of hemorrhage or transfusion was observed between the two groups （all P〉0.05）. （2） The autotransfusion volume was 385 （161-583） ml in the ICS group. Fifteen cases （20.0%） in the ICS group also received additional transfusions of leukocyte-reduced red blood cell （RBC） suspension, fresh frozen plasma and cryoprecipitate and two cases （3.3%） received additional transfusions of leukocyte-reduced RBC suspension and fresh frozen plasma. The two groups showed no significant difference in the cost of transfusion or per-capita transfusion volume of fresh frozen plasma or cryoprecipitate. However, the transfusion volume of leukocyte-reduced RBC suspension was lower in the ICS group as compared with that in the control group [M（P25-P75）, 1.9 （1.5-4.5） vs 4.1 （2.8-6.2） U, Z= - 2.800, P=0.005]. （3） There was no significant difference in complete blood count or coagulation function between the two groups before the operation. White blood cell （WBC） counts in the two groups were elevated following operation. Postoperative WBC count in the control group was higher than that in the ICS group, while the levels of RBC and hemoglobin were lower than those in the ICS group following operation （all P〈0.05）. （4） No amniotic fluid embolism was reported in the two groups. Only one case of rash was reported in the ICS group, which was fewer than the transfusion reactions occurred in the control group [1.7% （1/60） vs 13.3% （8/60）, x2=5.886, P=0.016]. （5） The two groups showed no significant difference in preoperative temperature, the highest temperature within three days after operation or incision healing. Compared with the patients in the control group, those in the ICS group had shorter hospital stay [（4.7±1.1） vs （6.3±1.8） d, t=-3.341, P〈0.05]. Conclusion ICS is a safe and effective measure for gravidas at higher risk of hemorrhage during cesarean section.