妊娠晚期孕妇自体全血保存期间血液质量变化

Changes of Autologous Blood of Late Pregnancy Women during Preservation

目的 研究妊娠晚期孕妇自体全血保存期间血液质量变化规律,以期为临床孕妇储存式自身输血提供理论指导。方法 选择于我院行自体血储存的妊娠晚期孕妇全血28例,随机分为常规抗凝组(组1)及增大抗凝剂比例组(组2)各14例,同时选择20例常规抗凝的同期女性无偿献血者全血作为对照,监测全血在不同保存期的凝血功能、血粘度、乳酸、血钾及血液外观等相关指标的变化,同时统计产科组自体储存全血的利用率。结果 血液采集后1 h,组1的PT、APTT值明显低于无偿献血组(P<0.05),FIB浓度明显高于无偿献血组 (P<0.01);随着血液保存时间延长,与无偿献血组相比,组1的APTT值、PT值逐渐延长 (P<0.05),EAI值、血钾及乳酸浓度逐渐升高 (P<0.05),FIB浓度逐渐下降 (P<0.05),而组2的上述指标与无偿献血组相比差异无统计学意义(P>0.05);组1全血于第3天出现细小颗粒凝集,至保存期末,组1、组2和对照组分别有18袋、11袋和10袋血液可以看到颗粒凝集现象;产科组储存全血利用率为3.6%(1/28)。结论 妊娠晚期孕妇自体储存全血处于高凝状态,常规抗凝的全血在保存期内凝血功能逐渐改变、乳酸产生增加、血钾浓度增高、血液黏度增加,且在第3天时已经出现微小凝集,储存时增大抗凝剂的比例可以有效解决这一问题。

Objective The study aimed to investigate the changes of autologous whole blood during the preservation in the third trimester of pregnancy and to provide theoretical guidance for preoperative autologous blood donationin pregnant women.Methods Twenty-eight late pregnancy women with autologous blood storage in our hospital were enrolled and divided equally into routine anticoagulant group(group 1)and high-anticoagulant group(group 2).At the sane time,20 cases of conventional anticoagulated female unpaid blood were selected as control.Then we monitored the changes of blood coagulation function,blood viscosity,lactic acid concentration,blood potassium and blood appearance in 3 groups during preservation,and counted the utilization rate of blood in the obstetric group.Results The PT and APTT values of group 1 were significantly lower than control(P<0.05),and FIB concentration was significantly higher than control(P<0.01)at 1 h.During the preservation,compared with the control group,the APTT value and PT value of group 1 were gradually prolonged(P<0.05),EAI value,blood potassium and lactic acid concentration were gradually increased(P<0.05),FIB concentration were gradually decreased(P<0.05),but there was no significant difference between group 2 and the control group(P>0.05).The blood of group 1 showed fine particle agglutination on the 3rd day.There were 18,11 and 10 bags of blood which showed Particle agglutination phenomenon;in group 1,group 2 and control group,respectively on the 35d.The utilization rate of preoperative autologous blood in obstetric group was 3.6%(1/28).Conclusion The blood of pregnant women in the third trimester is hypercoagulable.Conventional anticoagulated whole blood undergoes a change in blood quality during storage,manifested by increased lactic acid production,potassium concentration and blood viscosity,micro agglutination had occurred on the 3rd day.Increased proportion of anticoagulant during blood preservation can effectively solve this problem.