中央型前置胎盘剖宫产术中ANH与IOCS的应用比较

Acute normovolaemic haemodilution and intraoperative cell salvage in cesarean section patients with centra placenta praevia

目的探讨急性等容血液稀释(ANH)与术中回收式自体输血(IOCS)2种自体输血方式在中央型前置胎盘剖宫产术中的应用的有效性与适宜性。方法选取2016年8月至2019年3月廊坊市第四人民医院产科诊治的92例中央型前置胎盘剖宫产产妇作为研究对象。随机分为回收组(n=46)和稀释组(n=46)。两组手术方式均为子宫下段剖宫产术,回收组实施IOCS,稀释组实施ANH。记录两组术中出血量、血液输注量,观察比较两组自体血采集前(回收组为手术前5min,T0)、自体血回输后(T1)、关腹时(T2)、术后24 h(T3)平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、血红蛋白(Hb)、红细胞比容(Hct)、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)。记录两组新生儿Apgar评分、脐动脉血pH及产妇输血后并发症。结果两组术中出血量、自体血输注量、异体血输注量及异体血输注例数比较,差异无统计学意义(P>0.05)。两组不同时点MAP、HR、SpO2无明显变化,组间各时点MAP、HR、SpO2比较差异无统计学意义(P>0. 05)。与T0 比较,两组T2、T3、T4的Hb、Hct、PLT、Fib有所下降,PT、APTT有所延长,但均在正常参考值范围,组内组间比较差异无统计学意义(P>0. 05)。两组新生儿脐动脉血pH值、5分钟Apgar评分正常,差异无统计学意义(P>0. 05)。两组产妇自体血回输后均未出现溶血、感染、羊水栓塞等不良反应。结论 ANH与IOCS均是中央型前置胎盘剖宫产术中安全有效的输血方式。对于出血量较少的剖宫产手术,ANH应用的可行性更高,估计出血量较多时,可考虑与IOCS联合应用。

Objective To study the validity and feasibility of acute normovolaemic haemodilution(ANH)and intraoperative cell salvage(IOCS) in cesarean section patients with central placenta praevia. Methods 92 cesarean section patients with central placenta praevia were divided randomly into IOCS group(n=46) and ANH group(n=46) according to the methords received.Both groups underwent lower segment cesarean section.Intraoperative blood loss and blood transfusion of the two groups were recorded.Mean arterial pressure(MAP), heart rate(HR), blood oxygen saturation(SpO2), hemoglobin(Hb), hematocrit(Hct), platelet count(PLT), prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(Fib) were observed and compared at T0[before autogenous blood collection(ANH group),5 min before operation(IOCS group)], T1(after autogenous blood transfusion),T2(when abdomen was closed),T3(24 hs after operation).Neonatal Apgar score, umbilical artery blood pH and maternal complications after blood transfusion were recorded in both groups. Results There was no statistically significant difference in the amount of intraoperative blood loss, the amount of autologous blood transfusion, the amount of allogeneic blood infusion and the cases of allogeneic blood infusion between the two groups(P>0.05). There were no significant changes in MAP, HR, and SpO2 in the two groups. There were no significant differences in MAP, HR, and SpO2 between the groups(P>0.05). Compared with those at T0, Hb, Hct, PLT and Fib at T2, T3, T4 decreased, and PT, APTT extended in the two groups, but all in normal range, without statistically significant differences within and between the groups(P> 0. 05). There were no statistically significant differences in neonatal umbilical arterial blood pH and 5 minutes Apgar score between the two groups(P> 0.05).No haemolysis, infection, amniotic fluid embolism and other adverse reactions were found in the two groups. Conclusions IOCS and ANH are both safe and effective blood transfusion methods in the central placenta praevia. ANH is more feasible in cesarean section with less bleeding, which can be usedly jointly with IOCS when the amount of blood loss is estimated to be large.