高危妊娠剖宫产患者术中输血情况及危险因素分析

Study on intraoperative blood transfusion and analysis of risk factors in high-risk cesarean pregnancies

目的探讨高危妊娠剖宫产患者术中输血情况,并分析其危险因素。方法回顾性分析2022年1月至2023年8月西北妇女儿童医院收治的150例高危妊娠剖宫产患者,年龄29~43岁,孕周31~40周,根据术中是否输血将其分为输血组(63例)与未输血组(87例),比较两组患者的年龄、孕周、文化程度、既往史、病种分布、凝血指标等临床资料,利用多因素logistic回归分析确定高危妊娠剖宫产患者术中输血的危险因素。采用t检验、χ^(2)检验。结果输血组孕周≥37周、34~37周、≤34周分别有15例(23.81%)、32例(50.79%)、16例(25.40%),未输血组分别有68例(78.16%)、17例(19.54%)、2例(2.30%),差异有统计学意义(χ^(2)=46.679,P<0.001);输血组前置胎盘、胎盘植入、血红蛋白(Hb)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)与未输血组比较[77.78%(49/63)比13.79%(12/87)、87.30%(55/63)比11.49%(10/87)、(103.21±8.69)g/L比(117.75±10.25)g/L、(11.59±2.35)s比(10.22±2.01)s、(29.63±4.14)s比(27.22±3.89)s、(18.15±3.02)s比(16.81±2.86)s],差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,孕周延长及Hb水平升高均为高危妊娠剖宫产患者术中输血的保护因素(OR=0.074、0.733,均P<0.05),合并前置胎盘、合并胎盘植入及PT升高均为术中输血的独立危险因素(OR=102.338、258.237、1.964,均P<0.05)。结论在高危妊娠剖宫产患者中,孕周延长和Hb水平升高均是术中输血的保护因素,而合并前置胎盘、胎盘植入以及PT升高则是术中输血的独立危险因素。医生在进行高危妊娠剖宫产手术时应评估输血需求,并采取相应的预防措施。

Objective To explore the situation of intraoperative blood transfusion in high-risk cesarean delivery,and to analyze its risk factors.Methods A retrospective analysis was conducted on 150 cases of high-risk cesarean delivery admitted to Northwest Women's and Children's Hospital from January 2022 to August 2023,aged 29-43 years,with a gestational age of 31-40 weeks,and they were divided into a transfusion group(63 cases)and a non-transfusion group(87 cases)according to whether they receive blood transfusion during the operation.The clinical data such as age,gestational age,educational background,medical history,distribution of diseases,and coagulation indicators were compared between the two groups,and the risk factors for intraoperative blood transfusion in high-risk cesarean delivery were determined by multivariate logistic regression analysis.t test andχ^(2)test were used.Results In the transfusion group,there were 15 cases(23.81%)with a gestational age≥37 weeks,32 cases(50.79%)of 34-37 weeks,and 16 cases(25.40%)≤34 weeks,respectively,and those in the non-transfusion group were 68 cases(78.16%),17 cases(19.54%),and 2 cases(2.30%),with a statistically significant difference(χ^(2)=46.679,P<0.001).There were statistically significant differences in the placenta previa rate,placenta implantation rate,hemoglobin(Hb),prothrombin time(PT),activated partial thromboplastin time(APTT),and thrombin time(TT)between the transfusion group and the non-transfusion group[77.78%(49/63)vs.13.79%(12/87),87.30%(55/63)vs.11.49%(10/87),(103.21±8.69)g/L vs.(117.75±10.25)g/L,(11.59±2.35)s vs.(10.22±2.01)s,(29.63±4.14)s vs.(27.22±3.89)s,(18.15±3.02)s vs.(16.81±2.86)s](all P<0.05).Multivariate logistic regression analysis showed that prolonged gestational age and elevated Hb level were protective factors for intraoperative blood transfusion in high-risk cesarean pregnancy(OR=0.074 and 0.733,both P<0.05),and placenta previa,placental implantation,and elevated PT level were independent risk factors for intraoperative blood transfusion(OR=102.338,258.237,and 1.964,all P<0.05).Conclusions In high-risk cesarean pregnancy,prolonged gestation age and elevated Hb level are protective factors for intraoperative blood transfusion,while placenta previa,placenta implantation,and elevated PT level are independent risk factors.Physicians should better assess the need for blood transfusion during high-risk cesarean deliveries and take appropriate preventive measures.