Waters J H, Biscotti C, Potter P S, Phillipson E
Departments of General Anesthesiology, Obstetrics and Gynecology, and Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Anesthesiology. 2000 Jun;92(6):1531-6. doi: 10.1097/00000542-200006000-00008.
Cell salvage has been used in obstetrics to a limited degree because of a fear of amniotic fluid embolism. In this study, cell salvage was combined with blood filtration using a leukocyte depletion filter. A comparison of this washed, filtered product was then made with maternal central venous blood.
The squamous cell concentration, lamellar body count, quantitative bacterial colonization, potassium level, and fetal hemoglobin concentration were measured in four sequential blood samples collected from 15 women undergoing elective cesarean section. The blood samples collected included (1) unwashed blood from the surgical field (prewash), (2) washed blood (postwash), (3) washed and filtered blood (postfiltration), and (4) maternal central venous blood drawn from a femoral catheter at the time of placental separation.
Significant reductions in the following parameters were seen when the postfiltration samples were compared to the prewash samples (median [25th-75th percentile]): squamous cell concentration (0.0 [0.0-0.1 counts/high-powered field (HPF)] vs. 8.3 counts/HPF [4. 0-10.5 counts/HPF], P < 0.05); bacterial contamination (0.1 [0.0-0. 2] vs. 3.0 [0.6-7.7] colony-forming units (CFU)/ml, P < 0.01); and lamellar body concentration (0.0 [0.0-1.0] vs. 22.0 [18.5-29.5] thousands/microl, P < 0.01). No significant differences existed between the postfiltration and maternal samples for each of these parameters. Fetal hemoglobin was in higher concentrations in the postfiltration sample when compared with maternal blood (1.9 [1.1-2. 5] vs. 0.5% [0.3-0.7] ). Potassium levels were significantly less in the postfiltration sample when compared with maternal (1.4 [1.0-1.5] vs. 3.8 mEq/l [3.7-4.0]).
Leukocyte depletion filtering of cell-salvaged blood obtained from cesarean section significantly reduces particulate contaminants to a concentration equivalent to maternal venous blood.
由于担心羊水栓塞，细胞回收技术在产科的应用程度有限。在本研究中，细胞回收技术与使用白细胞滤除过滤器进行血液过滤相结合。然后将这种洗涤、过滤后的产物与母体中心静脉血进行比较。
对15例行择期剖宫产的妇女采集的4份连续血样进行鳞状细胞浓度、板层小体计数、定量细菌定植、钾水平和胎儿血红蛋白浓度的测定。采集的血样包括：(1)手术视野未洗涤的血液（洗涤前）；(2)洗涤后的血液（洗涤后）；(3)洗涤并过滤后的血液（过滤后）；(4)胎盘剥离时从股静脉导管抽取的母体中心静脉血。
将过滤后样本与洗涤前样本比较，以下参数显著降低（中位数[第25-75百分位数]）：鳞状细胞浓度（0.0[0.0-0.1个/高倍视野（HPF）]对8.3个/HPF[4.0-10.5个/HPF]，P<0.05）；细菌污染（0.1[0.0-0.2]对3.0[0.6-7.7]菌落形成单位（CFU）/毫升，P<0.01）；以及板层小体浓度（0.0[0.0-1.0]对22.0[18.5-29.5]千/微升，P<0.01）。这些参数在过滤后样本与母体样本之间均无显著差异。与母体血液相比，过滤后样本中的胎儿血红蛋白浓度更高（1.9[1.1-2.5]对0.5%[0.3-0.7]）。与母体相比，过滤后样本中的钾水平显著更低（1.4[1.0-1.5]对3.8毫当量/升[3.7-4.0]）。
对剖宫产获得的回收血细胞进行白细胞滤除过滤可显著降低微粒污染物浓度，使其与母体静脉血相当。
