凶险性前置胎盘剖宫产术中采用回收式自体输血的临床分析

Clinical analysis of recovery autotransfusion in operation of dangerous placenta previa

目的:研究回收式自体输血(IOCS)在凶险性前置胎盘的孕产妇剖宫产术中的临床应用。方法:选取35例进行剖宫产分娩,且术前确认为凶险性前置胎盘,在分娩过程中采用IOCS的孕妇为观察目标,观察记录手术前及手术结束24 h后的产妇血常规变化,凝血功能及肝肾功能在手术前后的区别;同时记录失血量,IOCS的血量、输入异体血、血浆和冷沉淀的量以及研究对象在输血过程中是否出现严重并发症;并登记产妇的恢复情况、新生儿出生时的重量及新生儿结局。结果:对于大出血产妇,IOCS技术能减少异体血及血液制品的使用;对于血常规、肝肾功能和凝血功能的检查,除红细胞压积(HCT)、凝血酶时间(TT)、丙氨酸转氨酶(ALT)和天冬氨酸氨基转移酶(AST)的含量,尿素氮与肌酐的含量在手术前后并无明显区别,其他指标除凝血酶原时间(PT)以及活化部分凝血活酶时间(APTT)较术前升高外,剩余指标均较试验前明显降低,但均处于正常参考范围。纳入研究的35例产妇中,有3例出现轻微不良反应,无严重的不良反应,安全性良好。35例产妇术后伤口愈合均良好,而新生儿平均体重为(2.71±0.46)kg,其中有4例出现轻度窒息,但并不严重。结论:IOCS技术在凶险性前置胎盘剖宫产手术中应用价值较高,它可以减少或消除异体输血相关风险,在手术中无严重不良反应出现,而且减少了异体血及血液制品的使用,缓解临床用血压力,且妊娠结局良好。

Objective To study the clinical application of intraoperative cell salvage in cesarean section of pregnant women with dangerous placenta previa. Method 35 pregnant women who underwent cesarean section and were confirmed as dangerous placenta previa before operation were selected as the observation targets. The blood routine changes of all selected objects before operation and 24 hours after operation were observed and recorded. The difference of coagulation function and liver and kidney function before and after operation was recorded. At the same time, the blood loss of pregnant women, the amount of blood transfused by recycled autologous transfusion, the amount of allogeneic blood, plasma and cryoprecipitate, and whether there were serious complications in the process of blood transfusion were recorded;The maternal recovery, neonatal weight and neonatal outcome were registered. Results For pregnant women with massive hemorrhage, IOCS technology can reduce the use of allogeneic blood and blood products. For the blood routine examination, liver and kidney function and coagulation function, except that the hematocrit, thrombin time, the contents of alanine aminotransferase and aspartate aminotransferase, and the contents of urea nitrogen and creatinine were not significantly different before and after operation, other indexes except prothrombin time and activated partial thromboplastin time were higher than those before operation, the remaining indexes were significantly lower than those before the experiment, but they were in the normal reference range. Among the 35 pregnant women included in the study, 3 cases had mild adverse reactions, no serious adverse reactions, and the safety was good. The wounds of 35 pregnant women healed well after operation, and the average weight of newborns was(2.71 ± 0.46)kg. Among them, 4 cases had mild asphyxia, but it was not serious.Conclusion The application value of recycling autologous blood transfusion technology in cesarean section of dangerous placenta previa is high. It can reduce or eliminate the risks related to allogeneic blood transfusion, there are no serious adverse reactions in the operation, reduce the use of allogeneic blood and blood products, alleviate clinical use of blood pressure of pregnant women, and the pregnancy outcome is good.