【摘要】：目的自體血貯備(PABD)可減少對異體血源需求,其在產(chǎn)科應(yīng)用的安全性已得到證實。文中分析孕期PABD在前置胎盤患者中的應(yīng)用價值,分別討論前置胎盤合并及未合并胎盤植入產(chǎn)婦的最適備血量。方法回顧性分析2015年1月至2016年4月期間在南京大學(xué)醫(yī)學(xué)院鼓樓醫(yī)院分娩的156例前置胎盤產(chǎn)婦病例資料,其中單純性胎盤植入及合并胎盤植入者各78例。分別根據(jù)術(shù)前備血量分為未備血組、備血300~400 mL組以及備血600 mL組。回顧孕婦分娩后產(chǎn)后出血量及對于同種異體紅細胞及血漿使用情況,分析術(shù)前PABD對減少分娩期用血作用。結(jié)果本組156例前置胎盤患者產(chǎn)后出血率49.4%,產(chǎn)后出血量230~5670mL,異體血輸注率為33.3%。未實施PABD者的異體血輸注高達48.2%(40/83);而實施孕期PABD患者的異體血輸注率僅為16.4%(12/73),差異有統(tǒng)計學(xué)意義(χ~2=17.624,P0.01)。前置胎盤患者分娩期異體血輸注率因其伴有胎盤植入情況而異。無孕期PABD者,分娩期的異體血輸注率為43.3%~53.8%;孕期備血1次(300~400mL)可滿足80%以上前置胎盤患者分娩期輸血的需要;孕期備血2次(600 mL)的單純性前置胎盤患者可避免異體用血。孕期PABD的前置胎盤患者仍有11.2%~13.3%的可能因產(chǎn)后出血過多、自體血貯備量不足而需要異體血的輸注。結(jié)論前置胎盤患者孕期實施PABD可降低分娩期與產(chǎn)后出血相關(guān)的異體血使用率和使用量,提高醫(yī)療安全。從醫(yī)學(xué)經(jīng)濟學(xué)高度考慮,推薦對有條件的前置胎盤患者孕期備血1次。
[Abstract]:Objective autologous blood reserve (PABD) can reduce the demand for allogeneic blood, and its safety in obstetrics has been proved. The application value of PABD in placenta previa during pregnancy was analyzed and the optimal blood volume of placenta previa combined with and without placenta accreta was discussed. Methods the data of 156 cases of placenta previa delivered in Gulou Hospital of Medical College of Nanjing University from January 2015 to April 2016 were retrospectively analyzed, including 78 cases of simple placenta accreta and 78 cases of complicated placenta accreta. According to preoperative blood volume, they were divided into three groups: unprepared blood group, 300 mL blood preparation group and 600 mL standby blood group. The amount of postpartum hemorrhage and the use of allogeneic red blood cells and plasma in pregnant women after delivery were reviewed and the effect of preoperative PABD on reducing blood consumption during delivery was analyzed. Results the rate of postpartum hemorrhage in 156 patients with placenta previa was 49.4%, the volume of postpartum hemorrhage was 230 ~ 5670 mL, and the transfusion rate of allogeneic blood was 33.3%. The rate of allogeneic blood transfusion was as high as 48.2% (40 / 83) in patients without PABD, but 16.4% (12 / 73) in patients with PABD during pregnancy, the difference was statistically significant (蠂 ~ 2 ~ (17.624) P 0.01). The rate of allogeneic blood transfusion varies with placenta accreta in patients with placenta previa. In the patients without PABD during pregnancy, the transfusion rate of allogeneic blood was 43.3% and 53.8% during delivery, and the need of blood transfusion during delivery could be satisfied for more than 80% of the patients with placenta previa once (300~400mL). Patients with simple placenta previa who prepare blood twice during pregnancy (600 mL) can avoid allogeneic blood use. In pregnant PABD patients with placenta previa, 11.2% of them may need allogeneic blood transfusion due to excessive postpartum hemorrhage and insufficient reserve of autologous blood. Conclusion PABD during pregnancy in placenta previa patients can reduce the utilization rate and usage of allogeneic blood associated with postpartum hemorrhage and improve medical safety. From the point of view of medical economics, it is recommended to prepare blood once during pregnancy for conditional placenta previa patients.
【作者單位】： 南京醫(yī)科大學(xué)附屬鼓樓醫(yī)院婦產(chǎn)科;南京紅十字血液中心;
【基金】：江蘇省臨床醫(yī)學(xué)中心(創(chuàng)新平臺)項目(YXZXB2016004) 南京市臨床醫(yī)學(xué)中心(寧政辦發(fā)[2014]9號)
【分類號】：R714.2

【參考文獻】

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