孕期自体血贮备减少前置胎盘患者分娩期异体血输注研究
发布时间：2018-12-30 13:44
【摘要】：目的自体血贮备(PABD)可减少对异体血源需求,其在产科应用的安全性已得到证实。文中分析孕期PABD在前置胎盘患者中的应用价值,分别讨论前置胎盘合并及未合并胎盘植入产妇的最适备血量。方法回顾性分析2015年1月至2016年4月期间在南京大学医学院鼓楼医院分娩的156例前置胎盘产妇病例资料,其中单纯性胎盘植入及合并胎盘植入者各78例。分别根据术前备血量分为未备血组、备血300~400 mL组以及备血600 mL组。回顾孕妇分娩后产后出血量及对于同种异体红细胞及血浆使用情况,分析术前PABD对减少分娩期用血作用。结果本组156例前置胎盘患者产后出血率49.4%,产后出血量230~5670mL,异体血输注率为33.3%。未实施PABD者的异体血输注高达48.2%(40/83);而实施孕期PABD患者的异体血输注率仅为16.4%(12/73),差异有统计学意义(χ~2=17.624,P0.01)。前置胎盘患者分娩期异体血输注率因其伴有胎盘植入情况而异。无孕期PABD者,分娩期的异体血输注率为43.3%~53.8%;孕期备血1次(300~400mL)可满足80%以上前置胎盘患者分娩期输血的需要;孕期备血2次(600 mL)的单纯性前置胎盘患者可避免异体用血。孕期PABD的前置胎盘患者仍有11.2%~13.3%的可能因产后出血过多、自体血贮备量不足而需要异体血的输注。结论前置胎盘患者孕期实施PABD可降低分娩期与产后出血相关的异体血使用率和使用量,提高医疗安全。从医学经济学高度考虑,推荐对有条件的前置胎盘患者孕期备血1次。
[Abstract]:Objective autologous blood reserve (PABD) can reduce the demand for allogeneic blood, and its safety in obstetrics has been proved. The application value of PABD in placenta previa during pregnancy was analyzed and the optimal blood volume of placenta previa combined with and without placenta accreta was discussed. Methods the data of 156 cases of placenta previa delivered in Gulou Hospital of Medical College of Nanjing University from January 2015 to April 2016 were retrospectively analyzed, including 78 cases of simple placenta accreta and 78 cases of complicated placenta accreta. According to preoperative blood volume, they were divided into three groups: unprepared blood group, 300 mL blood preparation group and 600 mL standby blood group. The amount of postpartum hemorrhage and the use of allogeneic red blood cells and plasma in pregnant women after delivery were reviewed and the effect of preoperative PABD on reducing blood consumption during delivery was analyzed. Results the rate of postpartum hemorrhage in 156 patients with placenta previa was 49.4%, the volume of postpartum hemorrhage was 230 ~ 5670 mL, and the transfusion rate of allogeneic blood was 33.3%. The rate of allogeneic blood transfusion was as high as 48.2% (40 / 83) in patients without PABD, but 16.4% (12 / 73) in patients with PABD during pregnancy, the difference was statistically significant (蠂 ~ 2 ~ (17.624) P 0.01). The rate of allogeneic blood transfusion varies with placenta accreta in patients with placenta previa. In the patients without PABD during pregnancy, the transfusion rate of allogeneic blood was 43.3% and 53.8% during delivery, and the need of blood transfusion during delivery could be satisfied for more than 80% of the patients with placenta previa once (300~400mL). Patients with simple placenta previa who prepare blood twice during pregnancy (600 mL) can avoid allogeneic blood use. In pregnant PABD patients with placenta previa, 11.2% of them may need allogeneic blood transfusion due to excessive postpartum hemorrhage and insufficient reserve of autologous blood. Conclusion PABD during pregnancy in placenta previa patients can reduce the utilization rate and usage of allogeneic blood associated with postpartum hemorrhage and improve medical safety. From the point of view of medical economics, it is recommended to prepare blood once during pregnancy for conditional placenta previa patients.
【作者单位】： 南京医科大学附属鼓楼医院妇产科;南京红十字血液中心;
【基金】：江苏省临床医学中心(创新平台)项目(YXZXB2016004) 南京市临床医学中心(宁政办发[2014]9号)
【分类号】：R714.2
[Abstract]:Objective autologous blood reserve (PABD) can reduce the demand for allogeneic blood, and its safety in obstetrics has been proved. The application value of PABD in placenta previa during pregnancy was analyzed and the optimal blood volume of placenta previa combined with and without placenta accreta was discussed. Methods the data of 156 cases of placenta previa delivered in Gulou Hospital of Medical College of Nanjing University from January 2015 to April 2016 were retrospectively analyzed, including 78 cases of simple placenta accreta and 78 cases of complicated placenta accreta. According to preoperative blood volume, they were divided into three groups: unprepared blood group, 300 mL blood preparation group and 600 mL standby blood group. The amount of postpartum hemorrhage and the use of allogeneic red blood cells and plasma in pregnant women after delivery were reviewed and the effect of preoperative PABD on reducing blood consumption during delivery was analyzed. Results the rate of postpartum hemorrhage in 156 patients with placenta previa was 49.4%, the volume of postpartum hemorrhage was 230 ~ 5670 mL, and the transfusion rate of allogeneic blood was 33.3%. The rate of allogeneic blood transfusion was as high as 48.2% (40 / 83) in patients without PABD, but 16.4% (12 / 73) in patients with PABD during pregnancy, the difference was statistically significant (蠂 ~ 2 ~ (17.624) P 0.01). The rate of allogeneic blood transfusion varies with placenta accreta in patients with placenta previa. In the patients without PABD during pregnancy, the transfusion rate of allogeneic blood was 43.3% and 53.8% during delivery, and the need of blood transfusion during delivery could be satisfied for more than 80% of the patients with placenta previa once (300~400mL). Patients with simple placenta previa who prepare blood twice during pregnancy (600 mL) can avoid allogeneic blood use. In pregnant PABD patients with placenta previa, 11.2% of them may need allogeneic blood transfusion due to excessive postpartum hemorrhage and insufficient reserve of autologous blood. Conclusion PABD during pregnancy in placenta previa patients can reduce the utilization rate and usage of allogeneic blood associated with postpartum hemorrhage and improve medical safety. From the point of view of medical economics, it is recommended to prepare blood once during pregnancy for conditional placenta previa patients.
【作者单位】： 南京医科大学附属鼓楼医院妇产科;南京红十字血液中心;
【基金】：江苏省临床医学中心(创新平台)项目(YXZXB2016004) 南京市临床医学中心(宁政办发[2014]9号)
【分类号】：R714.2
【参考文献】
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