基于多中心数据的回收式自体血回输在剖宫产术中的应用评价

Evaluation the application of intra-operative cell salvage in cesarean section based on multicenter data

目的探讨回收式自体血回输(IOCS)技术在剖宫产术中应用的安全性、有效性及应用指征。方法收集2016年8月—2019年1月全国11家三级甲等医院剖宫产术中应用IOCS技术输血的产妇共1265例,根据剖宫产术中出血量分为<1500 ml组(796例)和≥1500 ml组(469例)。回顾性分析产妇及新生儿的一般临床资料、超声检查征象、围产期及产褥期指标;应用logistic多因素回归模型分析影响产妇术中出血量≥1500 ml的危险因素。结果(1)1265例应用IOCS技术输血的产妇总回收血量共848001 ml,回输血量共418649 ml,相当于23258 U红细胞悬液,极大地节约了医疗资源。(2)<1500 ml组和≥1500 ml组的中位术中出血量分别为800 ml(300~1453 ml)和2335 ml(1500~20000 ml)。两组产妇均无羊水栓塞、严重输血不良反应、休克、死亡发生。(3)多因素分析显示,年龄≥35岁(OR=1.5,95%CI为1.1~1.9)、产前血红蛋白水平<110 g/L(OR=1.7,95%CI为1.3~2.2)、子宫手术史(OR=1.8,95%CI为1.3~2.6)、前置胎盘(OR=1.9,95%CI为1.1~3.1)、胎盘植入(OR=2.6,95%CI为1.8~3.9)、胎盘内存在血池(OR=1.6,95%CI为1.1~2.3)、胎盘后肌壁异常(OR=1.8,95%CI为1.2~2.6)、胎盘凸向子宫前壁(OR=3.0,95%CI为1.3~7.0)是显著影响产妇术中出血量≥1500 ml的危险因素(P均<0.05)。结论IOCS技术输血在剖宫产术中应用相对安全、有效,节约了医疗资源,但需要严格规范其应用指征。

Objective To investigate the safety,efficacy and application indication of intra-operative cell salvage(IOCS)in cesarean section.Methods A total of 1265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into<1500 ml group(796 cases)and≥1500 ml group(469 cases)according to the amount of blood loss during cesarean section.The general clinical data,ultrasonic imaging data,perinatal and puerperium indicators were analyzed retrospectively.The risk factors of intraoperative blood loss≥1500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results(1)A total of 848001 ml of blood was recovered and a total of 418649 ml of blood was transfused in 1265 pregnant women who received IOCS transfusions,which was equivalent to 23258 U red blood cell suspension,greatly saving medical resources.The intraoperative blood loss in<1500 ml group and≥1500 ml group was 800 ml(300-1453 ml)and 2335 ml(1500-20000 ml),respectively.No amniotic fluid embolism,severe adverse reactions,shock and death occurred in the two groups.(3)Multivariate regression analysis showed that age≥35 years(OR=1.5,95%CI:1.1-1.9),prenatal hemoglobin level<110 g/L(OR=1.7,95%CI:1.3-2.2),history of uterine surgery(OR=1.8,95%CI:1.3-2.6),placenta previa(OR=1.9,95%CI:1.1-3.1),placenta accreta(OR=2.6,95%CI:1.8-3.9),blood pool in the placenta(OR=1.6,95%CI:1.1-2.3),abnormal posterior placenta muscle wall(OR=1.8,95%CI:1.2-2.6),placenta projecting to the anterior uterine wall(OR=3.0,95%CI:1.3-7.0)were risk factors for blood loss≥1500 ml in obstetric transfusion using IOCS technique,with statistical significance(all P<0.05).Conclusion IOCS is safe and effective in cesarean section,which could save the medical resources and reduces medical expenses,however,it is necessary to strictly master the application indication.