稀释式自身输血在剖宫产中的应用

Application of hemodilutional autotransfusion to cesarean section

目的 评价血液稀释式自身输血应用于剖宫产的安全性和可行性。方法 对 5 2例无合并症的剖宫产孕妇在完成硬膜外诱导麻醉后 ,分别采血 40 0、60 0与 80 0ml,采血至 15 0ml时快速静脉滴注采血量 2倍量的稀释液 ,输液毕立即手术 ,手术临近结束或出血超过 3 0 0ml时回输自体血。观察母胎生命体征及血液稀释前后、回输血后、术后 2 4h血液成分、电解质、血黏度的变化及脐血气测定。结果 采血及回输血过程无副反应 ,母生命体征监测参数稳定 ,手术前后RBC、HGB、Plt在采血 40 0ml组差异显著 (P <0 .0 5 ) ,采血 60 0～ 80 0ml级无差别。PT、APTT轻度延长 ,但均在正常范围 ,血黏度、血球比积、纤维蛋白原、电解质无显著变化 (P >0 .0 5 )。结论 稀释式自身输血应用于剖宫产安全、可行。对HGB >110g L、体重 >70kg的孕妇 ,安全的采血量为 60 0～ 80 0ml,可大大减少手术中细胞丢失 ,降低产妇对同种异体血的需求。

Objective To evaluate the safety and feasibility of intraoperative hemodilutional autotransfusion in cesarean section.Methods Fifty-two parturients after epidural anesthesia received hemodilutional autotransfusion at the end of operation or earlier,if required.The vital signs of mother and fetus were observed.The blood paramenters,electroloyte and blood viscosity were detected before and after hemodilution,and after autotransfution as well as 24 hours after operation.The neonatal assessment was performed including umbillical blood gas and Apgar scores.Results All the patients were hemodynamically stable,and no side effects were observed during the process except for slight elongation of PT and APTT.There was no significant differences in hemoglobin and platelet count before hemodilution and 24 hours after operation in the group of blood collected from 600ml to 800 ml (P>0.05),however there was a significant difference in RBC,Hb and PLT in group of blood collected 400 ml (P<0.05).Conclusion The hemodilutional autotransfusion is effective and safe for pregnant women undergoing cesarean section,and the volume of blood collected from 600～800 ml is safe when the body weight of pregnant woman is over 70 kg and HGB over 110 g/L.