前置胎盘剖宫产术中不同输血方式对血常规及母婴结局的影响

目的比较不同输血方式在前置胎盘剖宫产术中的应用价值。方法收集2013年2月至2016年1月于本院行剖宫产分娩的82例前置胎盘孕妇的临床资料,按照输血方式分为自体组(自体贮血式输血,n=42)与异体组(异体输血,n=40),记录两组手术前后血红蛋白(Hb)、血小板计数(PLT)、红细胞比容(Hct)、白细胞计数(WBC)、红细胞计数(RBC)等血常规指标的变化,比较两组产后出血量,自体、异体输血量,观察两组妊娠结局,统计输血并发症。结果 (1)自体组累计出血量、异体输血量均低于异体组,差异有统计学意义(P0.05);(2)术后,两组PLT、WBC上升,RBC、Hb、Hct降低,自体组术后Hb、PLT、Hct水平均高于异体组,差异有统计学意义(P0.05);(3)两组出生后1min、5min新生儿阿普加评分(Apgar)及脐动脉血pH值对比差异无统计学意义(P0.05);(4)自体组总并发症发生率低于异体组,差异有统计学意义(P0.05)。结论在前置胎盘产妇剖宫产术中采用预存式自体输血方案,对产妇母婴结局无负面影响,同时可降低输血并发症发生率,安全可行,经济性高。

Effect of different blood transfusion modes during placenta previa cesarean section on blood routine and maternal and neonatal outcomes

Objective To compare the application values of different blood transfusion modes in placenta previa cesarean section.Methods The clinical data in 82 pregnant women with placenta previa undergoing cesarean section in our hospital from February 2013 to January 2016 were collected.The patients were divided into the autologous group (autologous blood stored blood transfusion,n=42) and allogeneic group (allogeneic blood transfusion,n=40) according to different blood transfusion modes.The changes of blood routine indexes such as hemoglobin (Hb),platelet count (PLT),hematocrit (Hct),white blood cell count (WBC) and red blood cell count (RBC) in the two groups before and after operation were recorded.Postpartum blood lossb amounts,autologous and allogeneic blood transfusion volume were compared between the two groups.The pregnant outcomes were observed,and the incidence rates of blood transfusion complications were statistically analyzed.Results (1)The accumulative blood loss volume and allogeneic blood transfusion volume in the autologous group were significantly lower than those in the allogeneic group (P<0.05);(2) PLT and WBC after operation in the two groups were significantly increased,while RBC,Hb and Hct were decreased.The levels of postoperative Hb,PLT and Hct in the autologous group were higher than those in the allogeneic group (P<0.05);(3) the neonatal Apgar scores at 1,5 min after birth,and umbilical artery blood pH value showed no statistically significant difference between the two groups (P>0.05);(4)The total incidence rate of complications in the autologous group was significantly lower than that in the allograft group (P<0.05).Conclusion Adopting autologous blood stored blood transfusion scheme during cesarean section in women with placenta previa has no negative effect on maternal and neonatal outcomes,meanwhile which can reduce the incidence of transfusion complications,is safe and feasible.