中华妇幼临床医学杂志（电子版）
中華婦幼臨床醫學雜誌（電子版）
중화부유림상의학잡지（전자판）
CHINESE JOURNAL OF OBSTETRICS & GYNECOLOGY AND PEDIATRICS(ELECTRONIC VERSION)
2014年
2期
226-229
,共4页
蔡大芬%陈红%陈玉环%鲍引娣
蔡大芬%陳紅%陳玉環%鮑引娣
채대분%진홍%진옥배%포인제
妊娠,异位%输血,自体
妊娠,異位%輸血,自體
임신,이위%수혈,자체
Pregnancy,ectopic%Blood transfusion,autologous
目的：探讨洗涤式自体血液回输在异位妊娠致腹腔内出血手术治疗中的安全性与有效性。方法选择2009年1月至2012年12月在湖北省孝感市中心医院妇产科就诊并确诊为异位妊娠的45例患者为研究对象,其年龄为17~42岁。分别接受急诊全身麻醉腹腔镜下患侧输卵管切除术,腹腔镜下患侧卵巢异位妊娠病灶切除+卵巢修补术或经腹患侧子宫角部楔形切除术。45例异位妊娠患者于术中采用洗涤式自体血液回输,观察其输血时有无不良反应,并动态监测患者术前和术后第2天血常规[红细胞(RBC)、白细胞(WBC)、血红蛋白(Hb)、红细胞压积(HCT)和血小板(PLT)]及凝血功能[凝血酶原时间(PT)及由其衍化出的国际标准化比值(INR)、部分凝血活酶时间(APTT)和纤维蛋白原(FIB)]水平变化,并进行统计学分析(本研究遵循的程序符合湖北省孝感市中心医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意)。结果本组45例患者中,术中腹腔内出血量为500~3000 mL,经血液回收机回收洗涤后回输自体血最多为1900 mL,最少为300 mL。术前和术后第2天RBC、WBC、Hb、HCT和PLT比较[(2.48±0.49)×1012/L vs.(3.81±0.35)×1012/L,(12.01±3.71)×109/L vs.(7.88±3.93)×109/L,(69.41±9.49)g/L vs.(79.01±8.83)g/L,0.26±0.04 vs.0.34±0.08,(125.98±54.31)×109/L vs.(171.34±59.69)×109/L],差异均有统计学意义(t=2.346,2.683,3.104,2.712,2.695；P<0.05)；术前和术后第2天凝血功能(PT、INR、APTT、FIB)比较[(11.98±0.99)s vs.(12.08±1.01)s,1.27±0.05 vs.1.26±0.06,(34.98±5.96)s vs.(35.13±4.37)s,(2.49±0.41)g/L vs.(2.51±0.39)g/L],均差异无统计学意义(t=1.963,1.622,1.653,1.882；P>0.05)。无一例患者输自体血时发生输血反应。结论异位妊娠术中采用洗涤式自体血液回输安全、有效,既可节约血源,又可降低输注异体血的风险。
目的：探討洗滌式自體血液迴輸在異位妊娠緻腹腔內齣血手術治療中的安全性與有效性。方法選擇2009年1月至2012年12月在湖北省孝感市中心醫院婦產科就診併確診為異位妊娠的45例患者為研究對象,其年齡為17~42歲。分彆接受急診全身痳醉腹腔鏡下患側輸卵管切除術,腹腔鏡下患側卵巢異位妊娠病竈切除+卵巢脩補術或經腹患側子宮角部楔形切除術。45例異位妊娠患者于術中採用洗滌式自體血液迴輸,觀察其輸血時有無不良反應,併動態鑑測患者術前和術後第2天血常規[紅細胞(RBC)、白細胞(WBC)、血紅蛋白(Hb)、紅細胞壓積(HCT)和血小闆(PLT)]及凝血功能[凝血酶原時間(PT)及由其衍化齣的國際標準化比值(INR)、部分凝血活酶時間(APTT)和纖維蛋白原(FIB)]水平變化,併進行統計學分析(本研究遵循的程序符閤湖北省孝感市中心醫院人體試驗委員會製定的倫理學標準,得到該委員會批準,併徵得受試對象的知情同意)。結果本組45例患者中,術中腹腔內齣血量為500~3000 mL,經血液迴收機迴收洗滌後迴輸自體血最多為1900 mL,最少為300 mL。術前和術後第2天RBC、WBC、Hb、HCT和PLT比較[(2.48±0.49)×1012/L vs.(3.81±0.35)×1012/L,(12.01±3.71)×109/L vs.(7.88±3.93)×109/L,(69.41±9.49)g/L vs.(79.01±8.83)g/L,0.26±0.04 vs.0.34±0.08,(125.98±54.31)×109/L vs.(171.34±59.69)×109/L],差異均有統計學意義(t=2.346,2.683,3.104,2.712,2.695；P<0.05)；術前和術後第2天凝血功能(PT、INR、APTT、FIB)比較[(11.98±0.99)s vs.(12.08±1.01)s,1.27±0.05 vs.1.26±0.06,(34.98±5.96)s vs.(35.13±4.37)s,(2.49±0.41)g/L vs.(2.51±0.39)g/L],均差異無統計學意義(t=1.963,1.622,1.653,1.882；P>0.05)。無一例患者輸自體血時髮生輸血反應。結論異位妊娠術中採用洗滌式自體血液迴輸安全、有效,既可節約血源,又可降低輸註異體血的風險。
목적：탐토세조식자체혈액회수재이위임신치복강내출혈수술치료중적안전성여유효성。방법선택2009년1월지2012년12월재호북성효감시중심의원부산과취진병학진위이위임신적45례환자위연구대상,기년령위17~42세。분별접수급진전신마취복강경하환측수란관절제술,복강경하환측란소이위임신병조절제+란소수보술혹경복환측자궁각부설형절제술。45례이위임신환자우술중채용세조식자체혈액회수,관찰기수혈시유무불량반응,병동태감측환자술전화술후제2천혈상규[홍세포(RBC)、백세포(WBC)、혈홍단백(Hb)、홍세포압적(HCT)화혈소판(PLT)]급응혈공능[응혈매원시간(PT)급유기연화출적국제표준화비치(INR)、부분응혈활매시간(APTT)화섬유단백원(FIB)]수평변화,병진행통계학분석(본연구준순적정서부합호북성효감시중심의원인체시험위원회제정적윤리학표준,득도해위원회비준,병정득수시대상적지정동의)。결과본조45례환자중,술중복강내출혈량위500~3000 mL,경혈액회수궤회수세조후회수자체혈최다위1900 mL,최소위300 mL。술전화술후제2천RBC、WBC、Hb、HCT화PLT비교[(2.48±0.49)×1012/L vs.(3.81±0.35)×1012/L,(12.01±3.71)×109/L vs.(7.88±3.93)×109/L,(69.41±9.49)g/L vs.(79.01±8.83)g/L,0.26±0.04 vs.0.34±0.08,(125.98±54.31)×109/L vs.(171.34±59.69)×109/L],차이균유통계학의의(t=2.346,2.683,3.104,2.712,2.695；P<0.05)；술전화술후제2천응혈공능(PT、INR、APTT、FIB)비교[(11.98±0.99)s vs.(12.08±1.01)s,1.27±0.05 vs.1.26±0.06,(34.98±5.96)s vs.(35.13±4.37)s,(2.49±0.41)g/L vs.(2.51±0.39)g/L],균차이무통계학의의(t=1.963,1.622,1.653,1.882；P>0.05)。무일례환자수자체혈시발생수혈반응。결론이위임신술중채용세조식자체혈액회수안전、유효,기가절약혈원,우가강저수주이체혈적풍험。
Objective To investigate the safety and effectiveness of clinical application of abstergent autologous blood transfusion in ectopic pregnancy surgery.Methods Between January 2009 and December 2009,abstergent autologous blood transfusion was done in 45 cases admitted in Central Hospital of Xiaogan who were diagnosed as ectopic pregnancy which fulfilled the set criteria.They accept emergency laparoscopic bilateral salpingectomy,general anesthesia with ovaries ovarian ectopic pregnancy lesion resection with repair and lateral angle of the uterus wedge resection.The side-effects,preoperative and postoperative blood routine indexes [red blood cell(RBC),white blood cell(WBC),hemoglobin(Hb),haematocrit(HCT),and platelet(PLT)]and coagulation function examination [prothrombin time (PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),fibrinogen(FIB)]were analyzed.The study protocol was approved by the Ethical Review Board of Investigation in Central Hospital of Xiaogan. Informed consent was obtained from all participates.Results In 45 cases of patients,intraoperative intraperitoneal bleeding amount were 500-3 000 mL,and the autologous blood transfusion volume varied from 300-1 900 mL.There had statistically significant differences between pre-operation and post-operation on levels of RBC,WBC,Hb,HCT and PLT [(2.48±0.49)×1012/L vs.(3.81±0.35)×1012/L, (12.01±3.71)×109/L vs.(7.88±3.93)×109/L,(69.41±9.49)g/L vs.(79.01±8.83)g/L,0.26± 0.04 vs.0.34±0.08,(125.98±54.31)×109/L vs.(171.34±59.69)×109/L;t=2.346,2.683,3.104, 2.712,2.695;P<0.05].And There had no statistically significant differences between pre-operation and post-operation on levels of PT,INR,APTT and FIB [(11.98±0.99)s vs.(12.08± 1.01)s,1.27±0.05 vs.1.26±0.06,(34.98±5.96)s vs.(35.13±4.37)s,(2.49±0.41)g/L vs.(2.51±0.39)g/L;t=1.963,1.622,1.653,1.882;P>0.05).No autologous blood transfusion complications occurred in all cases.Conclusions Intra-operative autotransfusion with this very simple,affordable and easily available technique is feasible and practical and its use should be encouraged.
