剖宫产术前储存式自体输血采血时机对剖宫产孕妇外周血液指标及妊娠结局的影响
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摘要
目的探讨储存式自体输血(PABD)采血时机对剖宫产孕妇外周血液指标及妊娠结局的影响。方法有中高危产后出血因素需行剖宫产术的孕妇167例,随机分为A组85例,B组82例,分别于术前7 d、术前3 d行PABD采血,两组采血量均为200 ml。比较两组孕产妇剖宫产术前、术后72 h Hb、红细胞比容(HCT)、PLT计数、凝血酶原时间(PT)、纤维蛋白原(FIB)水平及妊娠结局(产后24 h出血量、新生儿出生体重、新生儿出生1 min及5 min时Apgar评分、住院时间)、采血时孕妇、胎儿不良反应情况。结果两组孕妇术前、术后72 h外周血Hb、HCT、PLT、PT、FIB比较,差异均无统计学意义(均P>0.05)。两组产后24 h出血量、新生儿出生体重、新生儿出生1 min及5 min时Apgar评分比较,差异均无统计学意义(均P>0.05),但B组孕妇住院时间短于A组(P<0.05)。结论有中高危产后出血因素需行剖宫产术的孕妇在术前7 d或者3 d行PABD采血对孕产妇外周血各指标及妊娠结局均无不良影响,但剖宫产术前3 d行PABD采血可缩短产妇住院时间。
Objective To explore the effects of the blood collection timing of preoperative autologous blood donation( PABD) on the peripheral blood indices and pregnancy outcome in the pregnant women undergoing cesarean section. Methods Totally 167 pregnant women with moderate to high risk factors of postpartum hemorrhage and cesarean section were randomly divided into group A( n = 85) and group B( n = 82). Group A and group B underwent blood collection for PABD at 7 and 3 days before operation respectively,and the blood volume was 200 ml in both groups. The indices were compared between the two groups,including preoperative and postoperative 72-hour levels of Hb,hematocrit( HCT),PLT count,prothrombin time( PT) and fibrinogen( FIB),pregnancy outcome( including postpartum24-hour bleeding,neonatal birth weight,neonatal 1-and 5-minute Apgar scores and hospital stay),and adverse reactions of pregnant women and neonates during blood collection. Results There was no statistically significant difference between the two groups in the peripheral blood Hb,HCT,PLT,PT or FIB before operation and after 72 hours of operation( all P > 0. 05). The postpartum 24-hour hemorrhage,neonatal birth weight,neonatal 1-or 5-minute Apgar score showed no statistically significant difference between the two groups( all P > 0. 05).However,the hospital stay of the pregnant women in group B was shorter than that in group A( P < 0. 05). Conclusion Blood collection for PABD performed on the 7 th or 3 rd day before operation has no adverse effects on the peripheral blood indices or pregnancy outcome in the pregnant women with moderate to high risk factors of postpartum hemorrhage and cesarean section. Blood collection for PABD performed on the 3 rd day before cesarean section can reduce the puerpera's hospital stay.
Objective To explore the effects of the blood collection timing of preoperative autologous blood donation( PABD) on the peripheral blood indices and pregnancy outcome in the pregnant women undergoing cesarean section. Methods Totally 167 pregnant women with moderate to high risk factors of postpartum hemorrhage and cesarean section were randomly divided into group A( n = 85) and group B( n = 82). Group A and group B underwent blood collection for PABD at 7 and 3 days before operation respectively,and the blood volume was 200 ml in both groups. The indices were compared between the two groups,including preoperative and postoperative 72-hour levels of Hb,hematocrit( HCT),PLT count,prothrombin time( PT) and fibrinogen( FIB),pregnancy outcome( including postpartum24-hour bleeding,neonatal birth weight,neonatal 1-and 5-minute Apgar scores and hospital stay),and adverse reactions of pregnant women and neonates during blood collection. Results There was no statistically significant difference between the two groups in the peripheral blood Hb,HCT,PLT,PT or FIB before operation and after 72 hours of operation( all P > 0. 05). The postpartum 24-hour hemorrhage,neonatal birth weight,neonatal 1-or 5-minute Apgar score showed no statistically significant difference between the two groups( all P > 0. 05).However,the hospital stay of the pregnant women in group B was shorter than that in group A( P < 0. 05). Conclusion Blood collection for PABD performed on the 7 th or 3 rd day before operation has no adverse effects on the peripheral blood indices or pregnancy outcome in the pregnant women with moderate to high risk factors of postpartum hemorrhage and cesarean section. Blood collection for PABD performed on the 3 rd day before cesarean section can reduce the puerpera's hospital stay.
引文
[1]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:211-215.
[2]Tun9alp O,Souza JP,Gülmezoglu M,et al.New WHO recommendations on prevention and treatment of postpartum hemorrhage[J].Int J Gynaecol Obstet,2013,123(3):254-256.
[3]李翠,江新泉.自体输血的临床应用研究与进展[J].泰山医学院学报,2017(4):475-477.
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[5]刘宏敏,孙倩倩.Rh(D)阴性孕妇妊娠晚期预存式自体输血的应用效果观察[J].临床血液学杂志(输血与检验),2016,29(1):128-130.
[6]李曼榕,戴毅敏,王志群,等.产前贮存式自体备血的可行性及对母儿安全影响的研究[J].医学研究生学报,2014,27(10):1 060-1 064.
[7]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:182-184.
[8]胡丽华.临床输血学检验[M].3版.北京:人民卫生出版社,2012:1-5.
[9]Tamai K,Terai H,Toyoda H,et al.Which is the best schedule of autologous blood storage for preoperative adolescent idiopathic scoliosis patients?[J].Scoliosis,2015,10(Suppl 2):S11.
[10]晋晶,武广隆,张秋丽,等.预存式自体输血采集时机的探索研究[J].中国输血杂志,2016,29(11):1 252-1 254.
[11]陈骏萍,严敏.输血与血液保护[M].杭州:浙江大学出版社,2011:50.
[2]Tun9alp O,Souza JP,Gülmezoglu M,et al.New WHO recommendations on prevention and treatment of postpartum hemorrhage[J].Int J Gynaecol Obstet,2013,123(3):254-256.
[3]李翠,江新泉.自体输血的临床应用研究与进展[J].泰山医学院学报,2017(4):475-477.
[4]孔晓红,汪君.Rh(D)阴性血型孕妇预存式自体输血的临床应用[J].检验医学与临床,2012,9(15):1 940-1 941.
[5]刘宏敏,孙倩倩.Rh(D)阴性孕妇妊娠晚期预存式自体输血的应用效果观察[J].临床血液学杂志(输血与检验),2016,29(1):128-130.
[6]李曼榕,戴毅敏,王志群,等.产前贮存式自体备血的可行性及对母儿安全影响的研究[J].医学研究生学报,2014,27(10):1 060-1 064.
[7]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:182-184.
[8]胡丽华.临床输血学检验[M].3版.北京:人民卫生出版社,2012:1-5.
[9]Tamai K,Terai H,Toyoda H,et al.Which is the best schedule of autologous blood storage for preoperative adolescent idiopathic scoliosis patients?[J].Scoliosis,2015,10(Suppl 2):S11.
[10]晋晶,武广隆,张秋丽,等.预存式自体输血采集时机的探索研究[J].中国输血杂志,2016,29(11):1 252-1 254.
[11]陈骏萍,严敏.输血与血液保护[M].杭州:浙江大学出版社,2011:50.