自体血回收联合腹主动脉球囊临时阻断技术在凶险型前置胎盘伴胎盘植入剖宫产术中的应用

目的探讨回收式自体血回输联合腹主动脉球囊临时阻断技术在凶险型前置胎盘伴胎盘植入剖宫产术中的应用。方法选择2014年1月-2017年12月48例凶险型前置胎盘伴胎盘植入产妇,将其分成3组:球囊组、回收组和联合组,每组16例。球囊组患者应用球囊低位临时阻断腹主动脉技术,回收患者术中应用自体血回收,联合组患者同时应用回收式自体血回输和腹主动脉球囊临时阻断技术。比较3组产妇术中出血量、输血量、子宫壁缝合时间、新生儿评分、脐动脉血pH值;自体采血前(T1)、采血后即刻(T2)、关腹时(T3)、术后24 h(T4)各时点的血流动力学指标;血红蛋白(Hb)水平、血细胞比容(Hct)水平、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(Fib)。结果球囊组和回收组间各时点MAP、HR和SpO2均无统计学差异,且两组患者新生儿评分、脐动脉血pH值及Hb、Hct、PT、APTT和Fib均无统计学差异。与球囊组和回收组比较,联合组各时点MAP、HR和SpO2波动小;联合组各时点Hb、Hct、PT、APTT和Fib均有统计学差异,其中PT和Fib时间和分组因素有交互作用。与球囊组和回收组比较,联合组产妇T2、T3时点Hb、HCT和Fib水平增加(85.6±9.3/86.2±9.2 vs 95.5±8.6,109.9±6.7/108.6±7.5 vs 115.7±7.3;0.25±0.05/0.23±0.08 vs 0.30±0.07,0.29±0.05/0.29±0.06 vs 0.34±0.07;2.7±0.6/2.5±0.9 vs 3.4±0.7,2.9±0.8/3.0±1.0 vs 3.6±0.6,均为P<0.05),PT和APTT缩短13.2±1.1/13.5±1.3 vs 12.0±0.9,12.6±1.1/12.8±1.5 vs 11.8±0.8;35.5±3.7/35.6±3.5 vs 32.5±3.6,31.9±4.0/32.2±3.8 vs 29.2±2.5,均为P<0.05)及1 min Apgar评分增高(8.6±0.4/8.5±0.6 vs 9.1±0.6,均为P<0.05);与球囊组比较,回收组和联合组异体输血量减少(488.5±58.2 vs 135.8±66.5/122.6±35.0,均为P<0.05),但回收组和联合组异体输血量差异无统计学意义。3组产妇出血量、子宫壁缝合时间、子宫切除率、5 min Apgar评分和脐动脉血pH值差异无统计学意义。结论回收式自体血回输联合腹主动脉球囊临时阻断技术可改善凶险型前置胎盘伴胎盘植入产妇剖宫产术中的贫血、凝血功能和新生儿出生后即刻的身体状况。

The application of autologous blood salvage combined with temporary occlusion of abdominal aorta balloon in treating placenta previa associated with placenta accrete

Objective To explore the application of autologous blood salvage combined with temporary occlusion of abdominal aorta balloon in treating placenta previa associated with placenta accrete. Methods A total of 48 patients undergoing cesarean section owing to placenta previa associated with placenta accrete from January 2014 to December 2017 were selected. These patients were randomly divided into three groups: balloon, salvage and combined group(16 cases each group). Patients in ballon group received temporary occlusion of abdominal aorta balloon, those in salvage group underwent autologous blood salvage, and patients in combined group were given autologous blood salvage combined with temporary occlusion of abdominal aorta balloon. The intraoperative amount of bleeding, blood transfusion, the time of the suture of the uterus, Apgar score of neonates and pH value of umbilical artery blood among three groups were compared. Hemodynamic indexes, hemoglobin(Hb) and hematocrit(Hct) level, prothrombin time(PT), activated partial thromboplastin time(APTT) and fibrinogen(Fib) before autologous blood collection(T1), immediately after blood collection(T2), ventral closure(T3), 24 hours after operation(T4) among three groups were assessed. Results MAP, HR and SpO2 at each time points between balloon and salvage group were similar meanwhile the level of Apgar score, pH value of umbilical artery blood, Hb, HCT, PT, APTT and Fib at each time points between balloon and salvage group showed no statistical differences. Compared with balloon and salvage group, the fluctuation of MAP, HR and SpO2 at each time points in combined group were more slight and stable with no interaction between time and grouping factors respectively. Statistical differences of Hb, Hct, PT, APTT and Fib at each time points were noted among three groups, and there were interactions on PT and Fib between time and grouping factors. Compared with balloon and salvage group, the level of Hb, HCT and Fib at T2 and T3 time points in combined group increased, while PT and APTT decreased, and increased 1 min Apgar score was observed in combined group. In comparison with balloon group, patients in salvage and combined group both showed reduction of allogeneic blood transfusion;however, the volume of allogeneic blood transfusion between salvage and combined group were similar. The amount of bleeding, the time of the suture of the uterus, hysterectomy rate, 5 min Apgar score and pH value of umbilical artery blood between three groups were similar. Conclusion Reclaimed autologous blood transfusion combined with temporary occlusion of abdominal aorta balloon would improve the anemia, coagulation function and prognosis of newborns in patients undergoing cesarean section owing to placenta previa associated with placenta accrete.