腹主动脉球囊阻断联合回收式自体输血在凶险型前置胎盘剖宫产术中的应用

Application of abdominal aortic balloon occlusion combined with salvaged autologous blood transfusion in pernicious placenta previa cesarean section

目的探讨腹主动脉球囊阻断联合回收式自体输血在凶险型前置胎盘剖宫产术中的应用效果。方法选择行剖宫产术分娩的60例凶险型前置胎盘产妇,将在术前放置腹主动脉球囊,术中暂时阻断腹主动脉并回收式自体输血的30例患者作为观察组,按常规剖宫产操作的30例患者作为对照组(按指征输异体血)。比较两组出血与输血情况、手术前后血常规指标及围术期指标。结果观察组术中出血量、异体血浆输入量、异体红细胞悬液输入量及异体红细胞悬液输入率均低于对照组(均P<0.05),而两组产妇异体血浆输入率及术后24 h出血量比较,差异均无统计学意义(均P>0.05)。两组产妇术后8 h血小板计数、红细胞比容、红细胞计数及血红蛋白水平均低于术前(均P<0.05),但两组间上述指标差异均无统计学意义(均P>0.05)。观察组子宫切除率、产后出血发生率均低于对照组,抗生素使用时间短于对照组(均P<0.05),而两组产妇术后发热发生率、术后住院时间及新生儿体重比较,差异均无统计学意义(均P>0.05)。结论腹主动脉球囊阻断术联合回收式自体输血能明显减少凶险型前置胎盘产妇剖宫产术中出血量和抗生素使用时间,降低产妇产后出血率、异体血红细胞悬液输入率及子宫切除率,输血效果与输入同种异体血相当。

Objective To explore the application effect of abdominal aortic balloon occlusion combined with salvaged autologous blood transfusion in pernicious placenta previa caesarean section.Methods Sixty puerperae with pernicious placenta previa undergoing caesarean section for delivery were enrolled,30 cases(observation group)underwent abdominal aortic balloon placement before surgery,temporarily blocked the abdominal aorta during operation,and performed salvaged autologous blood transfusion,while 30 cases(control group)undertook conventional caesarean section procedures(allogeneic blood infusion based on the indications).Hemorrhage and blood transfusion,blood routine indexes before and after operation,and perioperative indexes were compared between the two groups.Results The intraoperative blood loss,allogeneic plasma input,allogeneic RBC suspension input,and allogeneic RBC suspension input rate in the observation group were lower than those in the control group(all P<0.05),however,there was no statistically significant difference between the two groups in maternal allogeneic plasma input rate or blood loss at hour 24 postoperatively(all P>0.05).The levels of PLT count,hematocrit,RBC count and hemoglobin at hour 8 postoperatively were lower than the levels before operation in the two groups(all P<0.05),but there was no statistically significant difference in the indexes mentioned above between the two groups(all P>0.05).The observation group had lower hysterectomy rate,lower incidence rate of postpartum hemorrhage,and shorter duration of antibiotic use than the control group(all P<0.05),moreover,no statistically significant difference was found in incidence rate of postoperative fever,postoperative hospital stay,or neonatal weight between the two groups(all P>0.05).Conclusion Abdominal aortic balloon occlusion combined with salvaged autologous blood transfusion can significantly reduce hemorrhage and duration of antibiotic use during cesarean section as well as postpartum hemorrhage rate,reduce the rate of maternal allogeneic RBC suspension input rate and the rate of hysterectomy in puerperae with pernicious placenta previa,having similar effect of blood transfusion as compared with allogeneic blood transfusion.