回收式自体输血在高出血风险产妇剖宫产术中的应用研究

Application of recovered autologous blood transfusion in cesarean section for puerperas with high risk of hemorrhage

目的探究回收式自体输血在高出血风险产妇剖宫产术中的应用效果。方法选取行剖宫产手术产妇100例,术前被诊断为具有高危出血风险,包括凶险性前置胎盘、胎盘植入、胎盘早剥、先兆子宫破裂以及疤痕子宫。依据输血方式不同,自体输血50例为观察组,异体输血50例为对照组。比较2组患者临床指标、血常规、凝血功能、炎症因子及术后不良反应。结果观察组术中失血量、术中输血量、血费、总费用、手术时间及住院时间少于或短于对照组,差异有统计学意义(P<0.05)。开始输血即刻(T_(1))时,2组产妇血常规指标比较差异均无统计学意义(P>0.05);输血结束(T_(2))及术后24 h(T_(3))时,2组红细胞压积(Hct)比较差异无统计学意义(P>0.05),观察组血红蛋白(Hb)、血小板(Plt)均高于对照组,差异有统计学意义(P<0.05)。T_(1)时,2组产妇凝血功能指标比较差异均无统计学意义(P>0.05);T_(2)、T_(3)时,2组D-二聚体(D-D)比较差异无统计学意义(P>0.05),观察组凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)均短于对照组,纤维蛋白原(Fib)高于对照组,差异有统计学意义(P<0.05)。输血后48 h,观察组血清降钙素原(PCT)、白细胞介素-6(IL-6)均低于对照组,差异有统计学意义(P<0.05);观察组过敏反应、感染及低血压发生人数均低于对照组,但2组产妇总不良反应发生率比较差异无统计学意义(P>0.05)。结论回收式自体输血在高出血风险产妇剖宫产术中的临床应用效果显著。

Objective To investigate the clinical application of recovered autologous blood transfusion in cesarean section for puerperas with high risk of hemorrhage.Methods A total of 100 puerperas with cesarean section were selected,and they were preoperatively diagnosed with high-risk hemorrhage,including perilous placenta previa,placenta accreta,placental abruption,threatened uterine rupture,and scarred uterus.According to the different blood transfusion methods,50 puerperas receiving autologous blood transfusion were assigned to observation group,and 50 puerperas receiving allogeneic blood transfusion were assigned to control group.Clinical indicators,blood routine tests,coagulation function,inflammatory factors,and postoperative adverse reactions were compared between the two groups.Results The intraoperative blood loss,intraoperative blood transfusion volume,blood costs,total costs,operative duration,and hospitalization time in the observation group were significantly shorter or lower than those in the control group.Immediately after blood transfusion(T_(1)),there were no significant differences in blood routine indicators between the two groups(P>0.05).At the end of blood transfusion(T_(2))and 24 hours after surgery(T_(3)),there was no significant difference in hematocrit(Hct)between the two groups(P>0.05),while the hemoglobin(Hb)and platelet(Plt)levels in the observation group were significantly higher than those in the control group(P<0.05).At T_(1),there were no significant differences in coagulation function indicators between the two groups(P>0.05).At T_(2)and T_(3),there were no significant differences in D-dimer(D-D)between the two groups(P>0.05),while the prothrombin time(PT),thrombin time(TT),and activated partial thromboplastin time(APTT)in the observation group were significantly shorter than those in the control group,and fibrinogen(Fib)was significantly higher in the observationgroup(P<0.05).At 48 hours after blood transfusion,the serum procalcitonin(PCT)and interleukin-6(IL-6)levels in the observation group were significantly lower than those in the control group(P<0.05).The number of cases with allergic reactions,infections,and hypotension in the observation group was significantly lower than that in the control group,but there was no significant difference in the total incidence rate of adverse reactions between the two groups(P>0.05).Conclusion Clinical application of recovered autologous blood transfusion in cesarean section for puerperas with high risk of hemorrhage shows remarkable effects.