剖宫产前后血红蛋白变化与出血量的关系研究

Study on the relationship between the hemoglobin change before and after cesarean delivery and hemorrhage volume

目的探讨孕产妇剖宫产前后血红蛋白(Hb)变化与出血量的关系。方法随机选取2020年1-9月在南京医科大学附属苏州医院定期产检并住院分娩的瘢痕子宫患者74例,按照术后6 h出血量分为轻度出血组(n=33,<300 ml)、中度出血组(n=29,300~600 ml)和重度出血组(n=15,601~1000 ml)。统计研究对象的一般情况,比较各组在术前、术后24、72 h的红细胞计数(RBC)、红细胞比容(HCT)、血小板(PLT)和Hb变化,并对其进行相关性分析。结果三组研究对象的一般资料比较,差异无统计学意义(P>0.05);重度出血组产妇术后6 h出血量明显大于轻度和中度出血组,差异有统计学意义(P<0.05);三组研究对象的术前RBC、HCT和PLT比较,差异无统计学意义(P>0.05);重度出血组术后24 h和72 h的RBC、HCT明显低于轻度出血组和中度出血组,差异有统计学意义(P<0.05);三组的PLT在术后24 h和72 h无明显变化,差异无统计学意义(P>0.05);轻度出血组的Hb在术后24 h和72 h无明显变化,差异无统计学意义(P>0.05);中度出血组的Hb在术后24 h和术后72 h明显低于术前,差异有统计学意义(P<0.05);重度出血组的Hb在术后24 h和术后72 h明显低于术前,差异有统计学意义(P<0.05);孕产妇的Hb与RBC呈正相关(r=0.558);孕产妇的Hb与HCT呈正相关(r=0.901);术后6 h出血量与术后24 h的Hb下降呈正相关(r=0.589);术后6 h出血量与术后72 h的Hb下降呈正相关(r=0.364)。结论孕产妇受回心血量的影响,轻度出血产妇术后血红蛋白无明显下降,Hb和HCT均能较好反映孕产妇的出血情况。

Objective To investigate the relationship between the hemoglobin(Hb)change before and after cesarean delivery and hemorrhage volume in pregnant women.Methods A total of 74 patients with scarred uterus who accepted regularly antenatal examination and delivered in the Affiliated Suzhou Hospital of Nanjing Medical University from January 2020 to September 2020 were randomly selected and divided into mild hemorrhage group(n=33,<300 ml),moderate hemorrhage group(n=29,300-600 ml)and severe hemorrhage group(n=15,601-1000 ml)according to the hemorrhage volume at 6 h after operation.The general conditions of the study subjects were counted.The changes in red blood cell(RBC),hematokrit(HCT),platelet(PLT)and Hb at 24 h and 72 h before and after operation were compared among the groups,and the correlation analysis was performed.Results There was no statistically significant difference in the general information of the three groups of study subjcts(P>0.05).The hemorrhage volume at 6 h after operation was significantly higher in the severe hemorrhage group than that in the mild hemorrhage group and the moderate hemorrhage group,with statistically significant difference(P<0.05).There were no statistically significant differences in preoperative RBC,HCT and PLT of the three study groups(P>0.05).The RBC and HCT in the severe hemorrhage group were significantly less than those in the mild hemorrhage group and the moderate hemorrhage group at 24 h and 72 h after operation,with statistically significant differences(P<0.05).There was no significant change in the PLT of the three groups at 24 h and 72 h after operation,without statistically significant difference(P>0.05).There was no significant change in the Hb of the mild hemorrhage group at 24 h and 72 h after operation,without statistically significant difference(P>0.05).The Hb in the moderate hemorrhage group at 24 h and 72 h after operation was significantly less than that before operation,with statistically significant difference(P<0.05).The Hb in the severe hemorrhage group at 24 h and 72 h after operation was significantly less than that before operation,with statistically significant difference(P<0.05).The maternal Hb was positively correlated with RBC(r=0.558)and was positively correlated with HCT(r=0.901).The hemorrhage volume at 6 h after operation was positively correlated with the decrease of Hb at 24 h after operation(r=0.589).The hemorrhage volume at 6 h after operation was positively correlated with the decrease of Hb at 72 h after operation(r=0.364).Conclusion The Hb shows no significant decrease after operation in pregnant women with mild hemorrhage as influenced by the returned blood volume,and both Hb and HCT can well reflect the hemorrhage conditions of pregnant wome n.