RhD阴性孕产妇输血相关因素及供血时限研究

Retrospective analysis of related factors and blood supply time limit of RhD negative obstetric transfusion

目的探讨产科RhD阴性孕产妇常规输血和紧急抢救输血的相关因素、输血时机和疗效。方法选取2009年1月至2019年12月首都医科大学附属北京妇产医院产科分娩并输血治疗的54例RhD阴性孕产妇,按照分娩方式分为剖宫产组、自娩组和产钳助产组,按照供血时限分为15 min组和2 h组。统计分析孕产妇基本信息、出血量及输血时机对疗效的影响等。结果37.0%(20例)RhD阴性产妇产后出血原因是子宫收缩乏力,其导致产妇产后2 h出血量和24 h出血量显著高于凝血功能异常导致的产后出血[950(650,1425)ml比305(250,462)ml;1127(820,1675)ml比320(270,480)ml,P<0.05],3组孕产妇年龄差异无统计学意义。剖宫产组输血前Hb显著高于产钳助产组[90.0(79.8,115.0)g/L比69.0(59.3,77.3)g/L,P<0.05)。产钳助产组输血后Hb显著高于输血前[86.5(74.5,95.5)g/L比69.0(59.3,77.3)g/L],红细胞比容(hematocrit,HCT)显著高于输血前[26.0(24.3,28.1)比20.7(18.0,24.3),P<0.05]。自娩组输血后HCT为24.8(22.4,25.7),显著低于剖宫产组和产钳助产组。不同分娩方式组间一般资料和输血前后其他血常规指标差异无统计学意义。出血量1000~1500 ml的孕产妇,15 min供血和2 h供血效果差异无统计学意义;出血量>1500 ml的孕产妇,2 h供血组输血后的Hb和HCT均显著低于15 min供血组[75.0(74.0,93.0)g/L比99.1(86.5,108.0)g/L;22.5(21.4,27.3)比29.6(25.7,31.3)]。结论临床应加强产科、输血科、血站的联动机制,做好RhD阴性孕产妇的备血管理,掌握输血时机,保证RhD阴性孕产妇的安全和及时供血。

Objective To analyze the related factors,timing and efficacy of RhD negative obstetric blood transfusion.Methods A total of 54 cases of RhD negative obstetric blood transfusion from January 2009 to December 2019 in Beijing Obstertrics and Gynecology Hospital were retrospectively analyzed.SPSS 19.0 was used to statistically analyze the basic information and related factors of patients’blood transfusion,the dose of blood products and the final outcomes.Results The main cause of postpartum hemorrhage(PPH)were uterine atony(37.0%)and the 2 h and 24 h PPH of this group were significantly higher than those of the group of coagulation abnormalities[950(650,1425)ml vs.305(250,462)ml;1127(820,1675)ml vs.320(270,480)ml,P<0.05],regardless of ages.The Hb before blood transfusion in cesarean section group was significantly higher than that of forceps delivery group[90.0(79.8,115.0)g/L vs.69.0(59.3,77.3)g/L,P<0.05].In the group of instrumental vaginal delivery(IVD),the Hb after blood transfusion was significantly higher than that before blood transfusion[86.5(74.5,95.5)g/L vs.69.0(59.3,77.3)g/L,P<0.05],HCT after blood transfusion was significantly higher than that before blood transfusion[26.0(24.3,28.1)vs.20.7(18.0,24.3),P<0.05].The HCT after blood transfusion in the delivery group was 24.8(22.4,25.7),which was significantly lower than those of the other two groups(P<0.05).There was no significant difference in the general data of the three groups of patients and other indicators before and after transfusion.There was no difference in blood supply between 15 min and 2 h when PPH was 1000-1500 ml.When PPH was>1500 ml,Hb and HCT after transfusion in the 2 h group were significantly lower than those in the 15 min group[75.0(74.0,93.0)g/L vs.99.1(86.5,108.0)g/L;22.5(21.4,27.3)vs.29.6(25.7,31.3)].Conclusions The cooperation between Department of Obstetrics,Department of Blood Transfusion and Blood Center should be strengthened,to ensure safe and timely blood supply for RhD negative pregnant women.