Yu Yu-Fang, Cao Yong-Dong
Department of Blood Transfusion, Hai'an People's Hospital Affiliated to Nantong University, Hai'an 226600, Jiangsu Province, China.
Department of Clinical Laboratory, Hai'an Qutang Central Health Center, Hai'an 226600, Jiangsu Province, China.
World J Clin Cases. 2022 Mar 16;10(8):2439-2446. doi: 10.12998/wjcc.v10.i8.2439.
Obstetric hemorrhage is the leading cause of maternal mortality globally, especially in China. The key to a successful rescue is immediate and rapid blood transfusion. Autotransfusion has become an integral part of clinical blood transfusion, with intraoperative cell salvage (IOCS) being the most widely used.
To investigate the application of IOCS in cesarean section.
A total of 87 patients who underwent cesarean section and blood transfusion in our hospital from March 2015 to June 2020 were included in this prospective controlled study. They were divided into the observation (43 cases) and control (44 cases) groups using the random number table method. The patients in both groups underwent lower-segment cesarean section. The patients in the control group were treated with traditional allogeneic blood transfusion, whereas those in the observation group were treated with IOCS. Hemorheology [Red blood cell count, platelet volume, and fibrinogen (FIB)] and coagulation function (partial prothrombin time, prothrombin time (PT), platelet count, and activated coagula-tion time) were measured before and 24 h after transfusion. In the two groups, adverse reactions, such as choking and dyspnea, within 2 h after cesarean section were observed.
Before and after transfusion, no significant differences in hemorheology and coagulation function indices between the two groups were observed ( > 0.05). About 24 h after transfusion, the erythrocyte count, platelet ratio, and FIB value significantly decreased in the two groups ( < 0.05); the PLT value significantly decreased in the two groups; the activated partial thromboplastin time, PT, and activated clotting time significantly increased in the two groups ( < 0.05); and no statistical differences were observed in hemorheology and coagulation function indices between the two groups ( > 0.05). Furthermore, there was no significant difference in the incidence of adverse reactions between the two groups ( > 0.05).
In patients undergoing cesarean section, intraoperative cell salvage has a minimum effect on hemorheology and coagulation function and does not increase the risk of amniotic fluid embolism.
产科出血是全球孕产妇死亡的主要原因，在中国尤为如此。成功抢救的关键是立即快速输血。自体输血已成为临床输血的重要组成部分，其中术中血液回收（IOCS）应用最为广泛。
探讨术中血液回收在剖宫产术中的应用。
本前瞻性对照研究纳入了2015年3月至2020年6月在我院行剖宫产术并输血的87例患者。采用随机数字表法将其分为观察组（43例）和对照组（44例）。两组患者均行下段剖宫产术。对照组患者采用传统异体输血治疗，观察组患者采用术中血液回收治疗。在输血前及输血后24小时测量血液流变学指标[红细胞计数、血小板体积和纤维蛋白原（FIB）]及凝血功能指标（活化部分凝血活酶时间、凝血酶原时间（PT）、血小板计数和活化凝血时间）。观察两组剖宫产术后2小时内呛咳、呼吸困难等不良反应情况。
输血前后，两组血液流变学及凝血功能指标比较，差异均无统计学意义（>0.05）。输血后约24小时，两组红细胞计数、血小板比例及FIB值均显著降低（<0.05）；两组血小板计数均显著降低；两组活化部分凝血活酶时间、PT及活化凝血时间均显著延长（<0.05）；两组血液流变学及凝血功能指标比较，差异无统计学意义（>0.05）。此外，两组不良反应发生率比较，差异无统计学意义（>0.05）。
剖宫产术中应用术中血液回收对血液流变学及凝血功能影响最小，且不增加羊水栓塞风险。
