产前贮存式自体备血的可行性及安全性研究

发布时间：2018-03-30 01:19

本文选题：贮存式自体备血(PABD)　切入点：产后出血(PPH)　出处：《南京大学》2014年硕士论文

【摘要】：目的探讨产前贮存式自体备血的可行性及对母儿安全性的影响。方法将产后出血高危孕妇按危险度分为高、中、低三组。于2013年1月至2013年12月,在南京大学医学院附属鼓楼医院定期产检并拟在本院住院分娩的,在知情同意基础上行PABD。观察孕妇采血前后血常规,血压、心率、末梢血氧饱和度及其他不良反应,电子胎心监护观察胎心变化,并跟踪妊娠结局,分析孕妇行PABD的安全性；并评估各组产时出血量、自体血回输情况及异体血运用。多组间比较运用单因素测量方差分析或重复测量的方差分析,相应多重比较采用LSD检验。非正态分布资料间比较采用秩和检验。结果92例接受PABD的孕妇,共采血115例次。采血指征包括产后出血高危(前置胎盘、多胎妊娠、羊水过多等)或血源困难(稀有血型)孕妇。低危组至高危组产前备血量中位数分别为300mL、300mL及400mL(p0.001)。 115例次采血前后,除孕妇采血后5 min,舒张压较采血开始时平均下降3.41mmHg (p0.05),采血结束时舒张压恢复外,其余监测生命征变化的参数无显著变化(p0.05)；胎心监护全部为反应型。PABD孕妇单次采血后HB和HCT较采血前分别平均降低5.4%和2.1%(p0.05),分娩前均恢复至采血前水平(p0.05)。两次行PABD的孕妇,HB和HCT变化与单次采血类似,92例孕妇平均产后出血量为821.6mL(全距120-8400)mL,需异体输血者5例,失血量均2000mL。无新生儿窒息和围产儿死亡。结论PABD可为产妇及时提供自体全血,在严格管理下,有指征地使用PABD技术具有合理性和安全性。产后出血高危孕妇或血源困难者(稀有血型)是PABD的主要适应证。
[Abstract]:Objective to explore the feasibility of autologous blood preparation in prenatal storage and its influence on maternal and infant safety. Methods the high, middle and low risk groups of postpartum hemorrhage were divided into three groups: January 2013 to December 2013. In the Gulou Hospital affiliated to Medical College of Nanjing University, PABD was performed on the basis of informed consent. Blood routine, blood pressure, heart rate, oxygen saturation of peripheral blood and other adverse reactions were observed before and after blood collection. Electronic fetal heart monitor was used to observe the changes of fetal heart, track the outcome of pregnancy, analyze the safety of PABD in pregnant women, and evaluate the amount of bleeding at birth in each group. Autologous blood transfusion and allogeneic blood use. LSD test was used for multiple comparison and rank sum test was used for non-normal distribution data. Results 92 pregnant women receiving PABD received blood samples for 115 times. The indications of blood collection included high risk of postpartum hemorrhage (placenta previa, multiple pregnancy, multiple pregnancy). Pregnant women with difficulty in blood supply (rare blood group). The median prenatal blood volume in the low risk group to the high risk group was 300 mL of amniotic fluid and 400 mL of P0. 001 mLp0. 001mLbefore and after 115 blood samples were taken. The diastolic blood pressure (DBP) of pregnant women decreased on average at 5 min after blood collection compared with that at the beginning of blood collection, and the diastolic blood pressure recovered at the end of the blood collection. There was no significant change in the other parameters of monitoring the change of life sign (p 0.05), and the fetal heart monitoring was all response type. The HB and HCT of pregnant women with single blood sampling decreased by 5.4% and 2.1%, respectively, and all recovered to the level before blood collection before delivery (P 0.05). The changes of HB and HCT in pregnant women were similar to those in single blood collection. The average postpartum hemorrhage of 92 pregnant women was 821.6mL (total distance 120-8400mL), and 5 cases needed allogeneic blood transfusion. There was no neonatal asphyxia and perinatal death. Conclusion PABD can provide autologous whole blood for parturient in time and under strict management. It is reasonable and safe to use PABD technique with indications. High risk pregnant women with postpartum hemorrhage or those with blood difficulties (rare blood group) are the main indications of PABD.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714

【参考文献】