回收式自体输血用于剖宫产大出血救治

Intraoperative cell salvage for major haemorrhage during cesarean delivery in 60 clinical cases

目的探讨回收式自体输血对产科大出血的临床意义。方法回顾性分析从2011年5月开展产科回收式自体输血以来,截止2016年1月间,剖宫产手术出血≥3 000 m L的病例60例的临床资料,包括估计出血量,自体血回输量及异体红细胞用量。结果在60例出血≥3 000 m L的病例中,有9例仅仅依靠单纯自体血回输提供了产妇大出血后体内红细胞的需要,51例在自体血回输基础上仍然需要供给额外的异体红细胞。出血量中位数(四分位间距)4 000 m L(3 150~5 850)m L;自体血回输量中位数(四分位间距)1 000 m L(500-1 300)m L;异体红细胞用量中位数是1 300 m L(600~2 400)m L。回输血量和出血量呈线性相关(R2=0.456,P<0.01),自体血回输量=0.189×出血量+92。所有产妇住院期间均未见自体输血相关不良反应发生。结论回收式自体输血可安全有效地用于大出血剖宫产手术。

Objective To discuss the application of intraoperative cell salvage（ IOCS） during cesarean delivery with major haemorrhage. Methods A retrospective analysis was performed using data acquired from 60 female treatment cases with a window between May 1 2011 and January 31 2016. All processed cases received IOCS during cesarean delivery and the blood loss was estimated to be more than 3 000 m L. Estimated blood loss,volume of autologous blood and allogeneic red cells transfused,and transfusion adverse reactions were recorded. Results In the 60 treatment cases,IOCS was used either alone（ n= 9） or in combination with allogeneic red cells（ n= 51）. The estimated blood loss volume median with autologous blood transfusion was 4 000 m L（ 3 150 ~ 5 850） m L while the median of allogeneic blood transfusion was 1 300 m L（ 600 ~ 2 400） m L and the median volume of re-infused blood was1 000 m L（ 500 ~ 1 300） m L. The volume of blood sourced from cell salvage was closely related to the blood loss volume（ P〈0. 000 01）,which fits the following modeling equation y = 0. 189 x＋92 with x for the blood loss volume and y for the blood volume from cell salvage. No complications related to IOCS were observed. Conclusion IOCS appears safe to be applied for clinical use and may potentially decrease the amount of allogeneic transfusion required during cesarean delivery if a major haemorrhage case were to occur.