围手术期血液管理对免疫性血小板减少症孕妇剖宫产临床结局的影响
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摘要
目的探讨围手术期血液管理对妊娠期免疫性血小板减少症(immune thrombocytopenia, ITP)剖宫产手术结局的影响。方法回顾性收集2016年6月至2018年5月行择期剖宫产的ITP患者,对照组选择同期因臀位或漏斗骨盆接受剖宫产的患者。结果 ITP组和对照组各入选79例产妇,采取手术开皮前血小板计数水平低于50×10~9/L预防性输入血小板,血红蛋白浓度低于80 g/L时输入压积红细胞等围术期血液管理措施治疗,两组患者手术时间、麻醉时间、新生儿娩出时间、Apgar评分、术中大出血比例(8.7%vs 4.8%,P=0.405)差异均无统计学意义,两组间出血量【(505±186)ml vs(406±268)ml,P=0.008)】和手术期间接受血小板的患者差异有统计学意义【73.4%vs 0,P <0.001】。结论根据血小板减少的程度输入血小板,对于合并贫血者积极纠正贫血等围手术期患者血液管理可使ITP剖宫产患者获得良好的妊娠结局。
Objective To investigate the effect of Patient Blood Management(PBM) on clinical outcome of parturient suffering from immune thrombocytopenia(ITP) undergoing cesarean section. Methods In this retrospective cohort study, pregnant women diagnosed as ITP who had programmed PBM measures undergoing cesarean section were included from June 2016 to May 2018. The Control Group included patients undergoing cesarean section due to breech fetus or funnel shaped pelvis during the same period. Results There were 79 women underwent cesarean section in each group. Duration of surgery, duration of anesthesia, delivery time, Apgar score, percentage of patients suffering from massive bleeding(>1 000 ml) were comparable between two groups. Blood loss during surgery were significantly higher in ITP group(505±186 ml vs. 406±268 ml, P=0.008)and more patients in ITP group(73.4% vs 0, P <0.001) received platelet transfusion during surgery. Conclusion PBM could help ITP patients safely undergo cesarean section with satisfactory maternal and fetal outcomes.
Objective To investigate the effect of Patient Blood Management(PBM) on clinical outcome of parturient suffering from immune thrombocytopenia(ITP) undergoing cesarean section. Methods In this retrospective cohort study, pregnant women diagnosed as ITP who had programmed PBM measures undergoing cesarean section were included from June 2016 to May 2018. The Control Group included patients undergoing cesarean section due to breech fetus or funnel shaped pelvis during the same period. Results There were 79 women underwent cesarean section in each group. Duration of surgery, duration of anesthesia, delivery time, Apgar score, percentage of patients suffering from massive bleeding(>1 000 ml) were comparable between two groups. Blood loss during surgery were significantly higher in ITP group(505±186 ml vs. 406±268 ml, P=0.008)and more patients in ITP group(73.4% vs 0, P <0.001) received platelet transfusion during surgery. Conclusion PBM could help ITP patients safely undergo cesarean section with satisfactory maternal and fetal outcomes.
引文
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[2]Reese JA,Peck JD,Deschamps DR,et al.Platelet Counts during Pregnancy[J].The New England journal of medicine,2018,379(1):32-43.
[3]Goodier CG,Lu JT,Hebbar L,et al.Neuraxial Anesthesia in Parturients with Thrombocytopenia:A Multisite Retrospective Cohort Study.[J].Anesth Analg,2015,121(4):988-991.
[4]陈哲,梁梅英,徐雪,等,免疫性血小板减少症妊娠期治疗相关并发症研究[J],中国妇产科临床杂志,2017,18(6):515-519.
[5]Daru J,Zamora J,Fernandez BM,et al.Risk of maternal mortality in women with severe anaemia during pregnancy and post partum:a multilevel analysis[J].The Lancet Global health,2018,6(5):e548-e54.
[6]梁梅英,徐雪.血液系统疾病孕前评估及孕期管理[J].中国实用妇科与产科杂志,2017,33(3):259-263.
[7]梁梅英,徐雪.妊娠合并血液系统疾病孕期保健及诊治中应关注的问题[EB/L].中华产科急救电子杂志,2015,4(1):1-4.