高容量血液稀释自体血回输对剖宫产凝血功能的临床观察

The Clinic Study of Coagulation Function in Cesarean Section with Undergoing Acute Hypervolemic Hemodilution Combined Intro-Operative Cell Salvage

目的:观察急性高容量血液稀释(AHH)联合自体血回输(ICS)对凶险性前置胎盘行剖宫产的患者围术期凝血功能的影响和不良反应。方法:选择南方医科大学附属佛山市妇幼保健院2017年7月至2018年6月产科择期凶险性前置胎盘剖宫产术患者60例,随机分为Ⅰ组和Ⅱ组,每组30例。常规禁食水,入手术室后Ⅱ组予羟乙基淀粉20 mL·kg^-1·h^-1进行AHH,Ⅰ组常规15 mL·kg^-1·h^-1予复方氯化钠注射液进行等容稀释,娩出胎盘前输注完毕;后所有患者左桡动脉和中心静脉穿刺置管,行动脉血压和中心静脉压监测,以咪唑安定、丙泊酚、舒芬太尼和顺式苯磺酸阿曲库铵快速静脉诱导后气管插管、机械通气。断脐后,术野自体血液回收、洗涤、浓缩、过滤后回输给产妇。记录术中、术后24 h内相关的生命体征、实验室检查结果。结果:两组患者的生命体征无明显差异。血液稀释后Ⅱ组患者的血红蛋白(Hb)、红细胞比容(HCT)、血小板计数(PLT)和纤维蛋白原(Fbg)浓度均较Ⅰ组降低,差异具有统计学意义(P<0.05);胎盘剥离后和术毕,Ⅱ组患者平均动脉压(MAP)、血红蛋白(Hb)、红细胞比容(HCT)、血小板计数(PLT)高于Ⅰ组患者,差异具有统计学意义(P<0.05)。结论:AHH联合ICS不影响凶险性前置胎盘患者剖宫产术围术期的凝血功能。

Objective To observe the perioperative coagulation function and adverse reaction in cesarean section patients suffered pernicious placenta previa undergoing acute hypervolemic hemodilution(AHH)combined intro-operative cell salvage(ICS).Methods Sixty patients suffered pernicious placenta previa in Foshan Maternal and Children’s Health Care Central were chosen to have selected cesarean section and all the patients were divided into two groups(Group Ⅰ and Group Ⅱ)randomly,thirty patients in each group.After fasting regularly,AHH was underwent in patients in Group Ⅱ after hetastarch 20 mL·kg^-1·h^-1 infusion and normovolemic hemodilution with compound sodium chloride 15 mL·kg^-1·h^-1 infusion in Group Ⅰ before baby borning.Left radial artery and central venous cannulation were done in all the patient to monitor blood pressure and central venous pressure.Mechanical ventilation was done after rapid sequence induction endotracheal intubation with midazolam,propofol,sufentani and cisatracurium.ICS was underwent after cord clamping.The vital signs and laboratory results were recorded in operation and the first twenty-four hours.Results There were no significant difference in two groups.Compared to Group Ⅰ,hemoglobin,haematocrit,platelet and fibrinogen in Group Ⅱ were lower in statistical significance(P<0.05)after hemodilution and mean arterial pressure,hemoglobin,haematocrit and platelet in Group Ⅱ were higher in statistical significance(P<0.05)after placental separation and at the end of operation.Conclusion There was no impact in perioprative coagulation function in cesarean section patients suffered pernicious placenta previa undergoing acute hypervolemic hemodilution(AHH)combined intro-operative cell salvage(ICS).