Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China.
Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China.
Chin Med J (Engl). 2020 Mar 20;133(6):638-643. doi: 10.1097/CM9.0000000000000699.
Cell salvage has recently been recommended for obstetric use in cases with a high risk of massive hemorrhage during cesarean section (CS). However, limited data are available to support the use of one suction device to collect lost blood. This study aimed to investigate the volume of red blood cells (RBCs) salvaged and the components of amniotic fluid (AF) in blood salvaged by one suction device or two devices during CS in patients with placenta previa and/or accrete.
Thirty patients with placenta previa and/or accrete undergoing elective CS in the Women's Hospital of Zhejiang University School of Medicine were recruited for the present study from November 1, 2017 to December 1, 2018. The patients were randomly assigned to one of the two groups according to an Excel-generated random number sheet: Group 1 (n = 15), in which only one suction device was used to aspirate all blood and AF, and Group 2 (n = 15), in which a second suction device was mainly used to aspirate AF before the delivery of the placenta. Three samples of blood per patient (pre-wash, post-wash, and post-filtration) were collected to measure AF components. The salvaged RBC volumes were recorded. Continuous data of pre-wash, post-wash, and post-filtration samples were analyzed by using one-way analysis of variance with Tukey's test for multiple comparisons, or Kruskal-Wallis test with Dunn test for multiple comparisons. Comparisons of continuous data between Group 1 and Group 2 were conducted using Student's t test or Mann-Whitney U test.
The salvaged RBC volume was significantly higher in Group 1 than that in Group 2 (401.6 ± 77.2 mL vs. 330.1 ± 53.3 mL, t = 4.175, P < 0.001). In both groups, squamous cells, lamellar bodies, and fat were significantly reduced by washing (all P<0.001) and squamous cells were further reduced by filtering (P < 0.001). Squamous cells were found in six post-filtration samples (three from each group). Lamellar bodies and fat were completely removed by filtering. Insulin-like growth factor binding protein 1, alpha-fetoprotein, albumin, lactate dehydrogenase, and potassium were significantly reduced post-wash (all P < 0.05), with no further significant reduction after filtration in either group (all P > 0.05). The mean percentage of fetal RBCs post-filtration was (1.8 ± 0.8)% with a range of 1.0% to 3.5% and (1.9 ± 0.9)% with a range of 0.7% to 4.0% in Groups 1 and 2, respectively, showing no significant difference between the two groups (U = 188.5, P = 0.651).
Cell salvage performed by one suction device could result in higher volume of salvaged RBCs and can be used safely for CS in patients with placenta previa and/or accrete when massive hemorrhage occurs.
ChiCTR-INR-17012926, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.
细胞回收最近被推荐用于剖宫产术中大出血风险较高的病例。然而，目前可用的数据有限，无法支持使用一种吸引装置来收集流失的血液。本研究旨在探讨在前置胎盘和/或胎盘粘连的患者中，使用一种或两种吸引装置在剖宫产术中回收红细胞（RBC）的量和回收血液中的羊水（AF）成分。
2017 年 11 月 1 日至 2018 年 12 月 1 日，浙江大学医学院附属妇产科医院招募了 30 名择期行剖宫产术的前置胎盘和/或胎盘粘连患者参与本研究。根据 Excel 生成的随机数表，患者被随机分配到两组之一：组 1（n=15），仅使用一种吸引装置抽吸所有血液和 AF；组 2（n=15），在胎盘娩出前主要使用第二种吸引装置抽吸 AF。每组患者采集 3 份血样（预洗、后洗和后过滤），以测量 AF 成分。记录回收的 RBC 量。采用单因素方差分析（Tukey 检验进行多重比较）或 Kruskal-Wallis 检验（Dunn 检验进行多重比较）分析预洗、后洗和后过滤样本的连续数据。使用 Student's t 检验或 Mann-Whitney U 检验比较组 1 和组 2 之间的连续数据。
组 1 回收的 RBC 量明显高于组 2（401.6±77.2ml vs. 330.1±53.3ml，t=4.175，P<0.001）。在两组中，经洗涤后，鳞状细胞、板层体和脂肪均显著减少（均 P<0.001），过滤后鳞状细胞进一步减少（P<0.001）。过滤后 6 份样本（每组 3 份）中均发现有鳞状细胞。板层体和脂肪经过滤后完全去除。胰岛素样生长因子结合蛋白 1、甲胎蛋白、白蛋白、乳酸脱氢酶和钾在洗涤后显著减少（均 P<0.05），但在两组中，过滤后均无进一步显著减少（均 P>0.05）。过滤后胎儿 RBC 的平均百分比为（1.8±0.8）%，范围为 1.0%至 3.5%，组 1 和组 2 分别为（1.9±0.9）%，范围为 0.7%至 4.0%，两组间无显著差异（U=188.5，P=0.651）。
使用一种吸引装置进行细胞回收可获得更多量的回收 RBC，并且当前置胎盘和/或胎盘粘连患者发生大出血时，可安全用于剖宫产术。
ChiCTR-INR-17012926，http://www.chictr.org.cn/，中国临床试验注册中心。
