自体血回输对剖宫产产后出血患者的异体输血需求与凝血功能及电解质的影响

Effect of intraoperative cell salvage on allogeneic blood transfusion requirements, coagulation function and electrolytes in postpartum hemorrhage of cesarean section

目的 探讨自体血回收输注对剖宫产产后出血患者的异体输血需求与凝血功能及电解质的影响。方法 选择本院2016年9月~2022年5月剖宫产产后出血患者137例,按术中是否使用自体血回输分为试验组(自体血组,70例)和对照组(异体血组,67例)。对2组手术失血量、异体红细胞和凝血成分的输注比例和量,血红蛋白(Hb)水平;凝血功能、电解质;以及并发症发生率、ICU入住比例和停留时间、住院时间等进行回顾性统计分析。结果 试验组异体红细胞输注率为37.1%vs 100.0%(P<0.05),血浆输注率为31.4%vs 53.7%(P<0.05)。2组术后24 h活化部分凝血活酶时间(APTT)和凝血酶原时间(PT)较术前延长,其中对照组APTT在出院时未恢复(P<0.05);2组纤维蛋白原(Fib)术后24 h均较术前降低(P<0.05)。与术前相比,2组血钙术后30 min降低,但试验组下降程度较轻(P<0.05),2组术后24 h均未恢复(P<0.05)。手术失血量、异体红细胞和凝血成分的输注量、Hb水平、并发症发生率、ICU入住比例和停留时间、住院时间等指标无差异(均为P>0.05)。结论 自体血回收输注用于剖宫产产后出血,可减少异体血需求,对凝血功能无明显抑制,需关注输血后钙离子的水平变化。

Objective To explore the effect of intraoperative cell salvage on allogeneic blood transfusion requirements, coagulation function and electrolytes in postpartum hemorrhage patients. Methods A study on postpartum hemorrhage patients undergoing cesarean section in the Third Affiliated Hospital of Guangxi Medical University form September 2016 to May 2022 was conducted retrospectively. A total of 137 patients were enrolled and divided into experimental group(n=70) and control group(n=67) according to whether intraoperative cell salvage was used during operation. The blood loss, proportion and volume of allogeneic red blood cells(RBCs) and coagulation component transfusion, hemoglobin(Hb) level, coagulation function, electrolyte, the incidence of complications, proportion of ICU admission, ICU stay and in-hospital stay were compared between the two groups. Results The proportion of patients receiving allogeneic RBCs in the experimental group and in the control group was 31.4% vs 100.0%(P<0.05). The experimental group also had lower use of plasma(31.4% vs 53.7%, P<0.05). The postoperative 24 h of activated partial thromboplastin time(APTT) and prothrombin time(PT) in the two groups was longer than preoperative, and APTT in the control group did not recover at discharge(P<0.05). Fibrinogen(Fib) decreased postoperative 24 h in the two groups(P<0.05). The blood calcium in the two groups decreased 30 minutes after operation, but the decrease in the experimental group was slight, and two groups did not recover 24 h after operation(P<0.05). There was no statically significant difference in blood loss, volume of allogeneic RBCs and coagulation component transfusion, Hb level, incidence of complications, the proportion of ICU admission, ICU stay and in-hospital stay(P>0.05). Conclusion This study demonstrated that intraoperative cell salvage could reduce the requirement for allogeneic RBCs without compromising coagulation function in postpartum hemorrhage patients undergoing cesarean section, but the changes of calcium need to be concerned after transfusion.