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  本文選題：貯存式自體備血(PABD)　切入點：產(chǎn)后出血(PPH)　出處：《南京大學》2014年碩士論文

【摘要】：目的探討產(chǎn)前貯存式自體備血的可行性及對母兒安全性的影響。方法將產(chǎn)后出血高危孕婦按危險度分為高、中、低三組。于2013年1月至2013年12月,在南京大學醫(yī)學院附屬鼓樓醫(yī)院定期產(chǎn)檢并擬在本院住院分娩的,在知情同意基礎上行PABD。觀察孕婦采血前后血常規(guī),血壓、心率、末梢血氧飽和度及其他不良反應,電子胎心監(jiān)護觀察胎心變化,并跟蹤妊娠結(jié)局,分析孕婦行PABD的安全性；并評估各組產(chǎn)時出血量、自體血回輸情況及異體血運用。多組間比較運用單因素測量方差分析或重復測量的方差分析,相應多重比較采用LSD檢驗。非正態(tài)分布資料間比較采用秩和檢驗。結(jié)果92例接受PABD的孕婦,共采血115例次。采血指征包括產(chǎn)后出血高危(前置胎盤、多胎妊娠、羊水過多等)或血源困難(稀有血型)孕婦。低危組至高危組產(chǎn)前備血量中位數(shù)分別為300mL、300mL及400mL(p0.001)。 115例次采血前后,除孕婦采血后5 min,舒張壓較采血開始時平均下降3.41mmHg (p0.05),采血結(jié)束時舒張壓恢復外,其余監(jiān)測生命征變化的參數(shù)無顯著變化(p0.05)；胎心監(jiān)護全部為反應型。PABD孕婦單次采血后HB和HCT較采血前分別平均降低5.4%和2.1%(p0.05),分娩前均恢復至采血前水平(p0.05)。兩次行PABD的孕婦,HB和HCT變化與單次采血類似,92例孕婦平均產(chǎn)后出血量為821.6mL(全距120-8400)mL,需異體輸血者5例,失血量均2000mL。無新生兒窒息和圍產(chǎn)兒死亡。結(jié)論PABD可為產(chǎn)婦及時提供自體全血,在嚴格管理下,有指征地使用PABD技術具有合理性和安全性。產(chǎn)后出血高危孕婦或血源困難者(稀有血型)是PABD的主要適應證。
[Abstract]:Objective to explore the feasibility of autologous blood preparation in prenatal storage and its influence on maternal and infant safety. Methods the high, middle and low risk groups of postpartum hemorrhage were divided into three groups: January 2013 to December 2013. In the Gulou Hospital affiliated to Medical College of Nanjing University, PABD was performed on the basis of informed consent. Blood routine, blood pressure, heart rate, oxygen saturation of peripheral blood and other adverse reactions were observed before and after blood collection. Electronic fetal heart monitor was used to observe the changes of fetal heart, track the outcome of pregnancy, analyze the safety of PABD in pregnant women, and evaluate the amount of bleeding at birth in each group. Autologous blood transfusion and allogeneic blood use. LSD test was used for multiple comparison and rank sum test was used for non-normal distribution data. Results 92 pregnant women receiving PABD received blood samples for 115 times. The indications of blood collection included high risk of postpartum hemorrhage (placenta previa, multiple pregnancy, multiple pregnancy). Pregnant women with difficulty in blood supply (rare blood group). The median prenatal blood volume in the low risk group to the high risk group was 300 mL of amniotic fluid and 400 mL of P0. 001 mLp0. 001mLbefore and after 115 blood samples were taken. The diastolic blood pressure (DBP) of pregnant women decreased on average at 5 min after blood collection compared with that at the beginning of blood collection, and the diastolic blood pressure recovered at the end of the blood collection. There was no significant change in the other parameters of monitoring the change of life sign (p 0.05), and the fetal heart monitoring was all response type. The HB and HCT of pregnant women with single blood sampling decreased by 5.4% and 2.1%, respectively, and all recovered to the level before blood collection before delivery (P 0.05). The changes of HB and HCT in pregnant women were similar to those in single blood collection. The average postpartum hemorrhage of 92 pregnant women was 821.6mL (total distance 120-8400mL), and 5 cases needed allogeneic blood transfusion. There was no neonatal asphyxia and perinatal death. Conclusion PABD can provide autologous whole blood for parturient in time and under strict management. It is reasonable and safe to use PABD technique with indications. High risk pregnant women with postpartum hemorrhage or those with blood difficulties (rare blood group) are the main indications of PABD.
【學位授予單位】：南京大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714

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本文編號：1683716