Hayata Eijiro, Nakata Masahiko, Takano Mayumi, Nagasaki Sumito, Oji Ayako, Sakuma Junya, Morita Mineto
Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan.
J Obstet Gynaecol Res. 2021 May;47(5):1743-1750. doi: 10.1111/jog.14738. Epub 2021 Mar 14.
Intraoperative cell salvage and autotransfusion (ICSA) is a useful technique for women undergoing cesarean sections who are predicted to experience significant bleeding. This method can reduce allogeneic transfusions as well as its associated risks and costs. Amniotic fluid embolism (AFE) is an abnormal maternal response to ICSA similar to the classic systemic inflammatory response syndrome, but its mechanism is not well understood. This study was conducted to investigate the biochemical aspects of AFE.
A prospective case-controlled pilot study was conducted in a general perinatal hospital in Japan. ICSA was performed using a two-step retransfusion process. Blood samples were collected presurgery, immediately postsurgery, and 24 h after surgery. Changes in sialyl Tn antigen (STN), complement C3 and C4, fibrinogen, and fibrin degradation product and D-dimer, C1 esterase inhibitor, and interleukin-8 (all considered AFE-related markers) activities were compared between patients who underwent cesarean sections with ICSA (ICSA group) versus without ICSA (control group).
Fibrinogen levels were significantly lower in the ICSA group than in the control group before surgery but not immediately after or 24 h after surgery. D-dimer was significantly higher immediately after surgery but not 24 h later. STN was significantly lower only before surgery. None of the AFE-related markers showed significant differences between the groups after 24 h. No adverse events were observed in the ICSA group.
There is no clinical evidence that ICSA alters the biochemical statuses of AFE-related markers in a manner that could lead to adverse maternal responses.
术中细胞回收与自体输血（ICSA）是一种对预计会发生大量出血的剖宫产妇女有用的技术。该方法可减少异体输血及其相关风险和成本。羊水栓塞（AFE）是母体对ICSA的一种异常反应，类似于经典的全身炎症反应综合征，但其机制尚不清楚。本研究旨在调查AFE的生化方面。
在日本一家普通围产期医院进行了一项前瞻性病例对照试验研究。采用两步回输法进行ICSA。在术前、术后即刻和术后24小时采集血样。比较接受ICSA剖宫产的患者（ICSA组）与未接受ICSA剖宫产的患者（对照组）之间唾液酸化Tn抗原（STN）、补体C3和C4、纤维蛋白原、纤维蛋白降解产物和D-二聚体、C1酯酶抑制剂和白细胞介素-8（均被视为与AFE相关的标志物）活性的变化。
ICSA组术前纤维蛋白原水平显著低于对照组，但术后即刻和术后24小时无差异。术后即刻D-二聚体显著升高，但24小时后无差异。仅术前STN显著降低。24小时后，各AFE相关标志物在两组之间均无显著差异。ICSA组未观察到不良事件。
没有临床证据表明ICSA会以可能导致母体不良反应的方式改变AFE相关标志物的生化状态。
