剖宫产手术自体血回收-回输的危险因素

Risk factors for autologous blood withdrawal-reinfusion in cesarean section

目的筛选剖宫产手术自体血回收-回输的危险因素。方法选择本院2012年8月至2015年6月进行自体血回收的剖宫产术产妇。收集产妇术前、术中和术后相关信息，根据是否进行自体血回输，分为回输组和未回输组。采用logistic回归分析筛选剖宫产手术自体血回收-回输的危险因素。结果共纳入1 604例进行自体血回收的产妇，回输组757例，未回输组847例。胎盘植入或穿透、凶险型前置胎盘、完全性前置胎盘是剖宫产术产妇进行自体血回收-回输的危险因素（P〈0.05）。预测模型为exp（w）÷[1＋exp（w）]，w＝1.447 ×胎盘植入或穿透（矫正OR值）＋0.945 ×完全性前置胎盘（矫正OR值）＋1.361×凶险型前置胎盘（矫正OR值）。该模型预测自体血回输敏感度56%，特度79%，阳性预测值为71%，阴性预测值为67%。结论胎盘植入或穿透、凶险型前置胎盘、完全性前置胎盘是剖宫产术自体血回收-回输的高风险因素，推荐常规准备自体血回收-回输。

Objective To determine the risk factors for autologous blood withdrawal-reinfusion in cesarean section.Methods Parturients who underwent cesarean section and autologous blood withdrawal from August 2012 to June 2015 in our hospital were selected.The preoperative, intraoperative and postoperative data of the parturients were collected retrospectively from electronic medical records.The parturients were divided into reinfusion group and non-reinfusion group according to whether the parturients received autologous blood reinfusion.Logistic regression analysis was used to stratify the risk factors for autologous blood withdrawal-reinfusion in cesarean section.Results A total of 1 604 parturients who received autologous blood reinfusion were included in the study, with 757 cases in reinfusion group and 847 cases in non-reinfusion group.Placenta increta/percreta, placenta previa with previous uterine surgery and complete placenta previa were the risk factors for autologous blood withdrawal-reinfusion in cesarean section （P〈0.05）. The predictive model was exp（w）÷[1＋ exp（w）], w=1.447×placenta increta/percreta （corrected OR value）＋ 0.945×complete placenta previa （corrected OR value）＋ 1.361×placenta previa with previous uterine surgery （corrected OR value）. The sensitivity and specificity of this model in predicting blood reinfusion were 56% and 79%, respectively, the positive predictive value was 71%, and the negative predictive value was 67%.Conclusion Placenta increta/percreta, placenta previa with previous uterine surgery and complete placenta previa are high risk factors for autologous blood withdrawal-reinfusion in cesarean section, and routine preparation for autologous blood withdrawal-reinfusion is recommended.