妊娠期自体血贮备在前置胎盘合并胎盘植入剖宫产中的应用

Application of preoperative autologous blood donation during pregnancy in cesarean section of placenta previa combined with placenta implantation

目的分析妊娠期自体血贮备(PABD)在胎盘前置(PP)合并或未合并胎盘植入产妇剖宫产中的应用。方法将2012年6月至2017年6月,98例于浙江省余姚市人民医院妇产科分娩的PP产妇作为研究对象,其中伴有胎盘植入者为植入组,无胎盘植入者为非植入组,两组各49例。分别比较两组患者中实施/未实施PABD者异体血输注情况,并分析PP患者分娩前不同PABD量与贫血发生率的关系。结果非植入组49例患者中,实施PABD 21例,未实施28例,两组患者产后出血发生率的比较无显著性差异(χ~2=0.03,P>0.05),异体血浆使用量比较无显著性差异(t=1.58,P>0.05),实施PABD组患者异体血输注率显著低于未实施PABD组患者(χ~2=5.03,P<0.05),且异体RCS使用量显著低于未实施PABD组患者(t=10.60,P<0.05)。植入组49例患者中,实施PABD 25例,未实施24例。30例产后出血的患者中,出血量≥2 000mL者7例(23.33%),1 000~2 000mL者9例(30.00%),<1 000mL者14例(46.67%)。两组患者产后出血发生率比较无显著性差异(χ~2=0.59,P>0.05),异体血浆使用量比较无显著性差异(t=1.66,P>0.05),实施PABD组患者异体血输注率显著低于未实施PABD组患者(χ~2=6.28,P<0.05),且异体RCS使用量显著低于未实施PABD组患者(t=10.30,P<0.05)。三组患者术前贫血发生率有显著性差异(χ~2=24.06,P<0.01),进一步每两组间比较发现,A组产妇术前贫血发生率显著高于B组和C组(χ~2值分别为20.61、6.40,均P<0.05)。三组轻度贫血发生率的比较,并无明显差异(χ~2=4.29,P>0.05)。三组中度贫血发生率的比较有显著性差异(χ~2=15.19,P<0.01)。结论对PP患者在符合条件的情况下可考虑采取PABD以有效减少妊娠期异体血输注率及输注量,改善医疗安全,建议具备条件的患者可于妊娠期进行1次备血。

Objective To analyze the application of preoperative autologous blood donation（PABD）in cesarean section of placenta previa（PP）with or without placental implantation.Methods A total of 98 PP pregnant women delivering in obstetrics and gynecology department of Yuyao People＇s Hospital from June 2012 to June 2017 were selected as research objects.Those with placenta implantation were selected as implantation group,and those without placenta implantation were selected as non implantation group,and each group included 49 cases.Allogenic blood transfusion was compared between patients with/without PABD in two groups.Relationship between PABD volume before delivery and anemia incidence was analyzed in PP patients.Results Among 49 patients in non implantation group,21 cases performed with PABD and 28 cases did not perform.There was no significant difference in postpartum hemorrhage incidence between two groups（χ~2=0.03,P〈0.05）,and there was no significant difference in use of allogeneic plasma in two groups（t=1.58,P〈0.05）.Allogenic blood infusion rate in PABD group was significantly lower than that of the non-PABD group（χ~2=5.03,P〈0.05）,and use of allogeneic RCS in PABD group was significantly lower than that in non PABD group（t=10.60,P〈0.05）.Among 49 patients in implantation group,25 cases were performed with PABD and 24 cases were not performed.Of 30 patients with postpartum hemorrhage,7 cases（23.33%）had blood loss of more than 2 000 mL,9 cases（30%）had blood loss of 1 000-2 000 mL,and 14 cases（46.67%）had blood loss1 000 mL.There was no significant difference in incidence of postpartum hemorrhage between two groups（χ~2=0.59,P〈0.05）,and there was no significant difference in use of allogeneic plasma in two groups（t=1.66,P〈0.05）.Rate of allogenic blood infusion in PABD group was significantly lower than that in non-PABD group（χ~2=6.28,P〈0.05）,and amount of allogenic RCS in PABD group was significantly lower than that in non PABD group（t=10.30,P〈0.05）.Incidence of anemia before operation in three groups was significantly different（χ~2=24.06,P〈0.01）,and comparison between each two groups showed that incidence of anaemia in group A was significantly higher than that in group B and C（χ~2 value was 20.61,6.40,respectively,both P〈0.05）.There was no significant difference in incidence of mild anemia among three groups（χ~2=4.29,P〈0.05）.There was a significant difference in incidence of moderate anemia among three groups（χ~2=15.19,P〈0.01）.Conclusion Eligible patients with PP can take PABD to effectively reduce transfusion rate and transfusion volume during pregnancy,and improve medical safety.It is suggested that eligible patients can perform autologous blood donation for 1 time during pregnancy.