自体血回输对剖宫产后大出血患者凝血功能转归的影响及体会

Effect of autologous blood transfusion on the recovery of coagulation function in patients with massive hemorrhage after cesarean section

目的探讨自体血回输对剖宫产后大出血患者凝血功能恢复的影响。方法纳入2020年1月至2022年7月收治于宿迁市妇幼医院产科发生剖宫产后大出血患者,使用分层区组随机化法将患者分为两组(每组30例):对照组(A组)、观察组(B组)。A组进行同种异体输血,B组进行自体血回输。记录两组患者术前12 h、术后12 h的红细胞(RBC)、血红蛋白(Hb)、血细胞比容(Hct)等血常规指标,凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)等凝血功能指标,血栓弹力图(TEG)R值、K值、α角、最大振幅(MA)值等指标。比较两组出血量>2000 ml的患者术前12 h、术后12 h血常规及凝血功能指标。记录两组患者术后不良反应(发热、感染、过敏、溶血)的发生情况。结果B组术后12 h Hb、Hct、RBC、Fib高于A组(均P<0.05),PT、APTT、TT低于A组(均P<0.05)。B组出血量>2000 ml的患者术后12 h Hb、Hct、RBC、Fib高于A组出血量>2000 ml的患者(均P<0.05),PT、APTT、TT低于A组出血量>2000 ml的患者(均P<0.05)。B组术后12 h R值、K值低于A组(均P<0.05),α角、MA值高于A组(均P<0.05)。B组发热、过敏发生率低于A组(均P<0.05)。其余指标差异无统计学意义(均P>0.05)。结论对于剖宫产后大出血患者,相较于异体输血,自体血回输的患者术后血液指标恢复情况可能更好,凝血功能的恢复也更快,不良反应的发生率更低。

Objective To investigate the effect of autologous blood transfusion on the recovery of coagulation function in patients with massive hemorrhage after cesarean section.Methods Patients who were admitted to Department of Obstetrics,Suqian Maternity and Children's Hospital with massive hemorrhage after cesarean section from January 2020 to July 2022 were included.According to the stratified randomization method,the patients were divided into two groups(n=30):a control group(group A)and an observation group(group B).Group A underwent homologous blood transfusion,while group B underwent autologous blood transfusion.Their blood routine indicators such as red blood cells(RBC),hemoglobin(Hb)and hematocrit(Hct),coagulation function indicators such as prothrombin time(PT),activated partial prothrombin time(APTT),thrombin time(TT),and fibrinogen(Fib),and thromboelastogram(TEG)R value,K value,angle α,and maximum amplitude(MA)value were recorded 12 h before and 12 h after surgery.Patients with bleeding volume>2000 ml in both groups were compared for the blood routine and coagulation function indicators 12 h before and 12 h after surgery.The incidences of postoperative adverse reactions(fever,infection,allergy and hemolysis)in the two groups were recorded.Results Compared with group A,group B showed increases in Hb,Hct,RBC and Fib(all P<0.05),and decreases in PT,APTT and TT on postoperative 12 h(all P<0.05).On postoperative 12 h,patients in group B with a bleeding volume>2000 ml presented increases in Hb,Hct,RBC,and Fib,compared with those in group A(all P<0.05),and decreases in PT,APTT,and TT,compared with those in group A(all P<0.05).On postoperative 12 h,the R value and K value in group B were lower than those in group A(all P<0.05),while the angleαand MA value were higher than those in group A(all P<0.05).The incidences of fever and allergy in group B were lower than those in group A(all P<0.05).There was no statistical difference in other indicators(all P>0.05).Conclusions For patients with massive hemorrhage after caesarean section,those undergoing autologous blood transfusion may show better recovery in terms of postoperative blood indicators,faster recovery of coagulation function,and lower incidences of adverse reactions than those with homologous blood transfusion.