妊娠合并血小板减少426例临床用血分析

Clinical blood using analysis of 426 pregnant women complicated with thrombocytopenia

目的:研究合并血小板减少孕妇在分娩时的用血情况及相关影响因素,为临床备血提供指导。方法:回顾分析山东大学齐鲁医院2016年1月至2019年6月收治的426例合并血小板减少孕妇的临床资料,根据血小板减少的轻重程度将其分为4组:Ⅰ组,血小板计数(101~125)×10^(9)/L,115例;Ⅱ组,血小板计数(51~100)×10^(9)/L,158例;Ⅲ组,血小板计数(21~50)×10^(9)/L,108例;Ⅳ组,血小板计数≤20×10^(9)/L,45例。分析4组孕妇的分娩方式及出血用血情况。结果:426例合并血小板减少孕妇中,50例(11.74%)选择经阴分娩,376例(88.26%)选择剖宫产结束分娩。4组的分娩方式比较,差异有统计学意义(P<0.05)。426例病例中有360例(84.50%)出血量低于1000mL;356例(83.57%)在分娩过程中输注了红细胞、血小板或其他血制品。出血量低于1000mL时,4组的出血量比较差异有统计学意义,Ⅰ组的出血量明显高于其他3组(P<0.05);Ⅳ组的输注红细胞比率明显高于其他3组,差异有统计学意义(P<0.05);Ⅰ组的输注血小板比率显著低于其他3组,差异有统计学意义(P<0.05);Ⅳ组的人均输注红细胞量较Ⅱ组、Ⅲ组显著升高,差异有统计学意义(P<0.05),Ⅳ组的人均输注血小板量显著高于其他3组,差异有统计学意义(P<0.05);出血量大于1000mL时,4组输注红细胞比率都达到100%;人均输注红细胞量各组间无显著差异(P>0.05),Ⅲ、Ⅳ组的人均输注血小板量显著高于Ⅰ、Ⅱ组(P<0.05)。356例用血病例均合并其他产科合并症,如瘢痕子宫、前置胎盘、子痫前期、特发性血小板减少症、再生障碍性贫血或其它结缔组织病等,Ⅰ组合并前置胎盘或凶险性前置胎盘明显高于其他3组;Ⅳ组合并再障或结缔组织病等相关疾病显著高于其他3组(P<0.05)。结论:妊娠合并血小板减少影响孕妇分娩方式的选择;孕妇其他合并症对血小板减少患者分娩时的出血及用血量的影响较大。

Objective:To research the clinical blood using and related influencing factors of pregnant women with thrombocytopenia during delivery, so as to provide guidance for clinical blood using preparation.Methods:The clinical data of 426 pregnant women with thrombocytopenia in Qilu hospital from January 2016 to June 2019 were reviewed.The pregnant women were divided into four groups according to the severity of thrombocytopenia: group I,platelet count(101~125)×10^(9)/L,115 cases;group Ⅱ,platelet count(51~100)×10^(9)/L,158 cases;group Ⅲ,platelet count(21~50)×10^(9)/L,108 cases;group Ⅳ,platelet count ≤20×10^(9)/L,45 cases.The delivery mode and blood use of the four groups were analyzed.Results:Among 426 pregnant women with thrombocytopenia, 50 cases(11.74%) of them chose vaginal delivery, while 376 cases(88.26%) of them chose caesarean section to finish delivery.There were significant difference in the choice of delivery mode among the four groups.84.50% cases had blood loss less than 1000 mL.About 83.57%(356 cases) were infused with red blood cells, platelets or other blood products during delivery.When the blood loss was lower than 1000 mL,there was significant difference in blood loss among the four groups, and the blood loss in group I was significantly higher than that in the other three groups(P<0.05).The rate of red blood cell transfusion in group Ⅳ was significantly higher than that in the other three groups(P<0.05).The platelet transfusion rate in group I was significantly lower than that in the other three groups.The per capita infusion of red blood cells in group IV was significantly higher than that in groups Ⅱ and Ⅲ(P<0.05),and the per capita infusion of platelet in group Ⅳ was significantly higher than the other three groups(P<0.05).When the blood loss was more than 1000 mL,the ratio of red blood cells transfused in the four groups reached 100%.There was no significant difference in RBC infusion per capita among all groups(P>0.05),and platelet infusion per capita in groups Ⅲ and Ⅳ was significantly higher than that in groups Ⅰ and Ⅱ(P<0.05).356 cases had other obstetric complications, such as scar uterus, placenta previa, severe eclampsia, idiopathic thrombocytopenia, aplastic anemia or other connective tissue diseases etc.,there was no significant difference.Group Ⅰ with placenta previa or dangerous placenta previa was significantly higher than the other three groups.Group Ⅳ combined with aplastic anemia or connective tissue disease and other related diseases were significantly higher than the other three groups(P<0.05).Conclusion:Pregnancy complicated with thrombocytopenia can affect the choice of delivery mode, but the other complications of thrombocytopenia in pregnant women had a great influence on the bleeding and blood using during delivery.