摘要
目的探讨输注不同剂量自体血对剖宫产产妇凝血功能的影响。方法选取2017-01/2018-06期间因前置胎盘或胎盘植入而剖宫产并在术中回收式自体输血的产妇32例,年龄20~45岁,平均年龄(30.3±2.5)岁,体质量50~85 kg,平均体质量(60.2±10.3)kg,ASA分级Ⅰ或Ⅱ级,分别于麻醉前(T_0),回输前(T_(1)),回输后10 min(T_(2)),回输后24 h(T_(3)),采集血液标本进行凝血功能和血栓弹力图(TEG)检测评估凝血功能,根据自体血回输量800 mL分为自体血回输量<800 mL和自体血回输量≥800 mL进行结果分析。结果32例未输注异体血或者血浆的剖宫产产妇纳入最后统计分析。其中22例自体血回输量<800 mL的产妇:T_(1)、T_(2)、T_(3)时,血小板(Plt)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)组间比较无统计学意义(P>0.05),反应时间(R)、凝固时间(K)、最大振幅(MA)、αAngle值组间比较无统计学意义(P>0.05);与T_(1)时比较,T_(2)和T_(3)的血红蛋白(Hb)、红细胞压积(Hct)较高(P<0.05)。T_0、T_(1)、T_(2)、T_(3)时,R、K、MA、αAngle值组间比较均无统计学意义(P>0.05);与T_0时比较,T_(1)、T_(2)、T_(3)的Plt、Fib值较小(P<0.05),PT、APTT比较无统计学意义(P>0.05);与T_(1)时比较,T_0、T_(2)、T_(3)的Hb、Hct较高(P<0.05);T_0、T_(2)、T_(3)的Hb、Hct组间比较无统计学意义(P>0.05)。10例自体血回输量≥800 mL的产妇:T_(1)、T_(2)、T_(3)时,Plt、PT、APTT、Fib组间比较差异无统计学意义(P>0.05),R、K、MA、αAngle值组间比较差异无统计学意义(P>0.05);与T_(1)时比较,T_(2)、T_(3)的Hb、Hct较高(P<0.05)。与T_0时比较,T_(1)、T_(2)、T_(3)的Hb、Hct、Plt、Fib值较低,PT、APTT值较高(P<0.05),R、K值较大,MA、αAngle值较小(P<0.05)。结论回收式自体输血量的大小可能会影响剖宫产产妇凝血功能,其中自体血回输量≥800 mL的产妇需要补充相应的凝血物质。
Objective To investigate the effect of different doses of salvaged blood autotransfusion on the coagulation function of parturients undergoing cesarean section.Methods A total of 32 cases of salvaged blood autotransfusion in cesarean section due to placenta previa and placenta implantation,aged from 20 to 45 years old,with an average age(30.3±2.5)years old,weighted 50 to 85 kg,with an average body weight(60.2±10.3)kg,ASA classificationⅠorⅡ,were selected from January 2017 to June 2018.Blood samples were collected before anesthesia(T_(0)),before reinfusion(T_(1)),10 min after reinfusion(T_(2)),and 24 h after reinfusion(T_(3))to evaluate coagulation function and intraoperative thromboelastography(TEG).According to the autologous blood transfusion volume of 800 mL,it was divided into two groups:autologous blood transfusion volume<800 mL and autologous blood transfusion volume≥800 mL for results analysisResults Altogether 32 patients who received cesarean section without transfusion of allogeneic blood or plasma were included in the final statistical analysis.Among them,22 patients received autologous blood transfusion(volume<800 mL).At T_(1),T_(2) and T_(3),there were no significant differences in Plt,PT,APTT and Fib between groups(P>0.05),and there were no significant differences in R,K,MA andαAngle between groups(P>0.05);compared with T_(1),Hb and Hct of T_(2) and T_(3) were higher(P<0.05).At T_(0),T_(1),T_(2) and T_(3),there were no significant differences in R,K,MA andαAngle values between groups(P>0.5);compared with T_(0),Plt and Fib values at T_(1),T_(2) and T_(3) were lower(P<0.05),there was no significant difference in PT and APTT(P>0.05);compared with T_(1),Hb and Hct of T_(0),T_(2) and T_(3) were higher(P<0.05);there was no significant difference in Hb and Hct of T_(0),T_(2) and T_(3)(P>0.05).Meanwhile 10 patients received autologous blood transfusion(volume≥800 mL).At T_(1),T_(2) and T_(3),there were no statistically significant differences in Plt,PT,APTT and Fib between groups(P>0.05),and there were no significant differences in R,K,MA andαAngle between groups(P>0.05);compared with T_(1),T_(2) and T_(3) had higher Hb and Hct(P<0.05).Compared with T_(0),the values of Hb,Hct,Plt and Fib of T_(1),T_(2) and T_(3) were lower,the values of PT and APTT were higher(P<0.05),the values of R and K were higher,and the values of MA andαAngle were lower(P<0.05).[HTH][WTHZ][CS%100,0,0,60]Conclusion The amount of salvaged blood autotransfusion may affect the coagulation function of parturients in cesarean section.Parturients with autologous blood transfusion volume≥800 mL need to be supplemented with the corresponding coagulation substances.
作者
余静
梅忠
宋丛中
YU Jing;MEI Zhong;SONG Congzhong(Department of Anesthesiology,Affiliated Xiaoshan Hospital,Hangzhou Normal University,Hangzhou 310012,China)
出处
《麻醉安全与质控》
2021年第4期193-197,共5页
Perioperative Safety and Quality Assurance
基金
杭州市卫计委科技项目(2017B26)。
关键词
回收式自体输血
剖宫产
凝血功能
血栓弹力图
autologous blood recovery
cesarean section
blood coagulation function
thrombolastogram
作者简介
通信作者:余静,主任医师,硕士,E-mail:1479304296@qq.com。
