摘要
目的探讨术中回收式自体输血(IOCS)在剖宫产术分娩中应用的有效性和安全性。方法选取2017年1月至2018年12月,于新疆维吾尔自治区妇幼保健院采取择期或者急诊剖宫产术分娩,并且因术中大出血采取IOCS治疗的99例产妇为研究对象。采用配对t检验,对本组99例产妇采取IOCS治疗前、后血常规、凝血功能及血流动力学指标进行比较,如血红蛋白(Hb)水平、舒张压、收缩压、心率等。分析99例产妇术中失血量、自体血液回输量、术中尿量及IOCS治疗导致的输血不良反应发生情况。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,征得产妇本人及其家属同意,并且签署临床研究知情同意书。结果①本组99例产妇术中失血量为(882.2±55.8)mL,自体血液回输量为(605.5±30.7)mL,自体血液回输率为100.0%(99/99),术中尿量为(400.5±20.5)mL。②本组99例产妇采取IOCS治疗后的Hb水平为(10.2±1.4)g/L,显著高于治疗前的(9.5±1.2)g/L;产妇采取IOCS治疗后的舒张压和收缩压分别为(75.2±8.1)mmHg(1mmHg=0.133kPa)和(120.2±3.5)mmHg,显著高于治疗前的(45.5±8.2)mmHg和(90.0±3.0)mmHg;治疗后产妇心率为(82.6±5.2)次/min,显著低于治疗前的(110.0±10.5)次/min,并且上述指标IOCS治疗前、后比较,差异均有统计学意义(t=16.595、16.887、3.818、12.855,P均<0.001)。③本组99例采取IOCS治疗的产妇中,无一例发生发热、皮疹、肺水肿、弥散性血管内凝血(DIC)、菌血症等输血不良反应。结论采取IOCS治疗剖宫产术分娩中发生的大出血产妇,安全、有效,对产妇凝血功能无明显影响,无严重输血不良反应。但是,因为本研究仅为回顾性研究,IOCS治疗剖宫产术分娩中发生的大出血,是否值得临床推广应用,尚需要大样本、多中心、随机对照研究结果证实。
Objective To investigate the effectiveness and safety of intraoperative cell salvage(IOCS)in cesarean section.Methods A total of 99 puerperae who underwent elective or emergency cesarean section and were treated with IOCS for intraoperative hemorrhea in Maternal and Child Health Hospital of Xinjiang Uygur Autonomous Region from January 2017 to December 2018 were enrolled into this study.The blood routine,coagulation and hemodynamics parameters of 99 puerperae before and after IOCS treatment were compared by pairwise t test,such as hemoglobin(Hb)level,diastolic blood pressure,systolic blood pressure and heart rate and so on.The volumes of intraoperative blood loss and autologous blood transfusion,urine volume and adverse reactions of IOCS were analyzed.This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.Chinical research informed consents were obtained from all the subjects and their family members.Results①The volume of intraoperative blood loss of 99 puerperae was(882.2±55.8)mL,the autologous blood transfusion volume was(605.5±30.7)mL,the autologous blood transfusion rate was 100.0%(99/99),and the intraoperative urine volume was(400.5±20.5)mL.②The Hb level of 99 puerperae after the treatment of IOCS was(10.2±1.4)g/L,which was significantly higher than that of(9.5±1.2)g/L before treatment;diastolic and systolic blood pressure after the treatment of IOCS were(75.2±8.1)mmHg(1 mmHg=0.133 kPa)and(120.2±3.5)mmHg,respectively,which were significantly higher than those of(45.5±8.2)mmHg and(90.0±3.0)mmHg before treatment;the heart rate was(82.6±5.2)times/min after the treatment of IOCS,which was significantly lower than that of(110.0±10.5)times/min before treatment,and all the differences above before and after the treatment of IOCS were statistically significant(t=16.595,16.887,3.818,12.855;all P<0.001).③Among the 99 puerperae treated by IOCS,none had adverse reactions of blood transfusion,such as fever,rash,pulmonary edema,disseminated intrav
作者
杨丽绢
林丽
高和新
Yang Lijuan;Lin Li;Gao Hexin(Department of Surgery Anesthesiology,Maternal and Child Health Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,Xinjiang Uygur Autonomous Region,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2019年第4期426-431,共6页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
新疆维吾尔自治区自然科学基金面上项目(2019D01A18)~~
关键词
输血
自体
外科手术中回收式输血
自体
剖宫产术
产后出血
血流动力学
孕妇
Blood transfusion,autologous
Operative blood salvage,autologous
Cesarean section
Postpartum hemorrhage
Hemodynamics
Pregnant women
