摘要
目的探讨在穿透性胎盘植入患者剖宫产术中应用回收式自体输血(IOCS)的效果。方法回顾性收集郑州大学第一附属医院产科2018年6月至2019年6月收治的接受剖宫产术的穿透性胎盘植入患者的临床资料。按照年龄、孕周、孕产次、胎盘植入程度及剖宫产术中出血量进行倾向性评分匹配,筛选出基线一致的患者共60例。根据术中血液制品输注情况将患者分为同种异体输血组(A组)和自体血回输组(B组),每组30例。比较两组术中出血量、围手术期输血情况。比较两组手术前和术后48 h血红蛋白(Hb)、红细胞比容(HCT)、血小板(PLT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐、K^+、Ca^2+、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)。比较两组术后并发症、住院时长、用血费用。结果两组产妇术中出血量比较,差异无统计学意义(P>0.05)。B组产妇术中及围手术期输注异体血量少于A组(P<0.05)。两组术后Hb、HCT、PLT水平均低于术前,B组术后Hb水平高于A组(P<0.05)。两组术后PT、APTT均较同组术前延长,两组术后Fib水平较同组术前降低(P<0.05)。B组术后AST和肌酐水平较术前升高(P<0.05)。两组术后Ca^2+水平均较术前下降(P<0.05)。两组术后HR均较术前加快,两组术后SpO 2较术前下降(P<0.05)。两组术后PT、APTT、Fib、ALT、AST、肌酐、K^+、Ca^2+、MAP、HR、SpO 2水平比较,差异无统计学意义(P>0.05)。B组产妇并发症总发生率较A组低(P<0.05)。两组术后最高体温、术后住院时长、用血费用比较,差异无统计学意义(P>0.05)。结论对穿透性胎盘植入产妇剖宫产术中应用IOCS是有效的,可大大减少异体血制品输注及相关并发症,缓解血资源紧缺的状况。
Objective To investigate the effect of intraoperative cell salvage(IOCS)in cesarean section of patients with penetrating placenta implantation.Methods The clinical data of patients with penetrating placenta implantation who underwent cesarean section admitted to the Department of Obstetrics in the First Affiliated Hospital of Zhengzhou University from June 2018 to June 2019 were collected retrospectively.According to age,gestational age,pregnancy times,the degree of placenta accreta and intraoperative blood loss,60 patients with consistent baseline were screened out.According to the infusion of blood products during operation,the patients were divided into allogeneic transfusion group(group A)and autotransfusion group(group B),with 30 cases in each group.The intraoperative blood loss and perioperative blood transfusion were compared between the two groups.The levels of hemoglobin(Hb),hematocrit(HCT),platelet(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine,K^+,Ca^2+,mean arterial pressure(MAP),heart rate(HR)and oxygen saturation(SpO2)were compared between the two groups before and 48 hours after operation.The postoperative complications,postoperative hospital stay and blood expenses were compared between the two groups.Results There was no statistical difference in intraoperative blood loss between the two groups(P>0.05).The amounts of intraoperative and perioperative allogeneic blood transfusion in group B were lower than those in group A(P<0.05).The levels of Hb,HCT and PLT after operation in both groups were lower than those before operation(P<0.05).After operation,the level of Hb in group B was higher than that in group A(P<0.05).After operation,PT and APTT in both groups were longer than those before operation,and the levels of Fib in both groups were lower than those before operation(P<0.05).After operation,the levels of AST and creatinine in group B were higher than those before operation(P<0.05).T
作者
张旭茹
赵先兰
ZHANG Xu-ru;ZHAO Xian-lan(Department of Obstetrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2020年第34期6367-6371,共5页
Henan Medical Research
关键词
穿透性胎盘植入
回收式自体输血
同种异体输血
剖宫产
penetrating placenta implantation
intraoperative cell salvage
allogeneic blood transfusion
cesarean section
