Rh(D)阴性产妇围产期红细胞输注的影响因素分析

An analysis of the factors influencing perinatal red blood cell transfusion of the Rh(D)negative puerperae

目的分析Rh(D)阴性产妇围产期红细胞输注的危险因素。方法回顾性分析301例Rh(D)阴性产妇的临床资料。其中,60例围产期输注红细胞(输注红细胞组),241例未输注红细胞(未输注红细胞组)。分析产妇的基本资料和实验室检测指标,采用多因素logistic回归分析评估围产期红细胞输注的影响因素。结果输注红细胞组与未输注红细胞组孕周及双胎妊娠、产前Hb<100g/L、瘢痕子宫、剖宫产、前置胎盘和产后出血量>1000mL比例有统计学差异(P<0.05)。多因素logistic回归分析显示,产前Hb<100g/L(OR=29.031,P<0.01)、剖宫产(OR=13.074,P<0.01)和产后出血量>1000mL(OR=23.756,P<0.01)是Rh(D)阴性产妇围产期红细胞输注的独立危险因素。180例产妇于分娩前贮存式自体备血共219U,其中28例产妇回输了自体血(回输率为15.56%)。结论产前Hb<100g/L、剖宫产和产后出血量>1000mL是Rh(D)阴性产妇围产期红细胞输注的独立危险因素。对具有高出血风险的Rh(D)阴性产妇进行贮存式自体备血,既可缓解异体血液资源紧缺,又可保障产妇安全用血。

Objective To analyze the factors influencing perinatal red blood cell transfusion of the Rh(D)negative puerperae.Methods The clinical data of 301Rh(D)negative puerperae were analyzed retrospectively,of whom 60cases were given red blood cell transfusion(group A,)and 241 cases did not(group B).Basic maternal data and laboratory test indicators were analyzed with multivariate logistic regression analysis.Results The gestational age and proportions of twin pregnancy,prenatal Hb<100g/L,scar uterus,Cesarean section,placenta previa,postpartum blood loss>1000mL were significantly different between the two groups(P<0.05).Multivariate logistic regression analysis showed that prenatal Hb<100g/L(OR=29.031,P<0.01),Cesarean section(OR=13.074,P<0.01)and postpartum blood loss>1000mL(OR=23.756,P<0.01)were the independent risk factors for perinatal red blood cell transfusion of the Rh(D)negative puerperae.A total of 219units autologous blood were stored from 180puerperae before delivery.Autologous blood re-transfusion rate was 15.56%.Conclusion Prenatal Hb<100g/L,Cesarean section and postpartum blood loss>1000mL are the independent risk factors of perinatal red blood cell transfusion in Rh(D)negative puerperae.For Rh(D)negative puerperae with high risk of bleeding,implementation of pre-deposit autologous blood donation can not only alleviate the shortage of allogeneic blood but also safeguard transfusion safety.