术中自体血液回输在剖宫产术中出血的应用初探

目的：探讨术中自体血液回输（intraoperative cell salvage，IOCS）于剖宫产术中应用的可行性及安全性。方法：回顾性分析2013年1月-2017年12月于陆军军医大学附属新桥医院因前置胎盘行剖宫产术571例患者，观察组（264例）同意并接受术中自体血液回输，对照组（307例）仅签署了知情同意书表示必要时进行异体血输注。比较2组一般资料、围手术期情况和输血后并发症等指标。结果：观察组术中出血量较对照组多，差异有统计学意义（Z=-6.993，P=0.000）。观察组输血总量≥2 000 mL者比例高于对照组，血浆、冷沉淀、血小板输注量也高于对照组，但异体红细胞悬液输注量较对照组少，差异有统计学意义（均P＜0.05）。2组患者术后入住重症监护室（ICU）时间、血红蛋白（Hb）、红细胞压积（HCT）和血小板计数（PLT）水平比较差异均无统计学意义（均P＞0.05）。2组患者输血后24 h内不良反应发生率比较，差异无统计学意义（均P＞0.05）。结论：前置胎盘患者剖宫产术中运用自体血回输安全可行。

Initial Experiences of Intraoperative Cell Salvage during Hemorrhage in Cesarean Section

Objective：The aim of this article is to determine the feasibility and safety of intraoperative cell salvage (IOCS) technology in obstetric hemorrhage during cesarean section. Methods：Data of intraoperative blood salvage in the Army Medical University affiliated Xinqiao Hospital from January 2013 to December 2017 were analyzed. A total of 571 patients were included in this study, who were diagnosed for placenta previa and underwent cesarean section. 264 women who signed informed consent for accepting IOCS and received re-infusion were included in the observation group, 307 women signed informed consent allogeneic transfusion when necessary were included in the control group. Baseline demographic data, laboratory and perioperative findings, transfusion adverse effects were analyzed. Results：In the observation group, blood loss was more than that in the control group (Z=-6.993, P=0.000). The proportion of cases with total blood transfusion ≥2 000 mL, transfusion of plasma, cryoprecipitate, and platelet were more than those in the control group, but the amount of erythrocyte transfusion was less than those in the control group(P＜0.05). However, there were no significant differences regarding of the days of postoperative ICU the preoperative and postoperative Hb, HCT, PLT levels(P＞0.05). Postoperative complications within 24 hours were no significant differences between the two groups (P＞0.05). Conclusions：The strategy of intraoperative cell salvage was feasible and safe for women with placenta previa undergoing cesarean section.