CAJ | 학술논문

目的：术前自体备血（ preoperative autologous blood donation ， PABD）可减少对异体血源的需求，但备血时可引起孕妇短时间大量失血，对胎儿及孕妇的安全性尚未充分评估。文章探讨PABD的可行性及对母儿安全性的影响。方法设置符合PABD的纳入标准，募集2013年1月至2013年12月间在南京大学医学院附属鼓楼医院定期产检并拟在本院住院分娩的孕妇，在知情同意基础上行PABD。参照2013年美国加州围产期出血高危分类临床标准，将PABD孕妇分为低危组、中危组及高危组。观察孕妇采血前后血常规、血压、心率、末梢血氧饱和度及其他不良反应变化情况，电子胎心监护观察胎心变化，分析孕妇行PABD的安全性，并评估各组产时出血量、自体血回输情况及分娩结局。结果92例接受PABD的孕妇共采血115例次。低危组、中危组和高危组产前备血量中位数分别为300、300及400 mL。115例次孕妇采血后5 min舒张压较采血开始时平均下降3．4 mmHg，差异有统计学意义（P＜0．05）；采血结束时反映监测生命征变化的参数差异无统计学意义（P＞0．05）；胎心监护全部为反应型。 PABD孕妇单次采血后血红蛋白和红细胞压积（hematocrit， HCT）较采血前平均降低5．4％和2．1％，差异均有统计学意义（P＜0．05），分娩前均恢复至采血前水平。2次行PABD的孕妇血红蛋白和HCT变化与单次采血类似，但第2次采血后血红蛋白、HCT与采血前相比差异无统计学意义（ P＞0．05）。所有孕妇分娩后无新生儿窒息和围产儿死亡。结论 PABD可为产妇及时提供自体全血。在严格管理下，有指征地使用PABD技术具有合理性和安全性。
목적：술전자체비혈（ preoperative autologous blood donation ， PABD）가감소대이체혈원적수구，단비혈시가인기잉부단시간대량실혈，대태인급잉부적안전성상미충분평고。문장탐토PABD적가행성급대모인안전성적영향。방법설치부합PABD적납입표준，모집2013년1월지2013년12월간재남경대학의학원부속고루의원정기산검병의재본원주원분면적잉부，재지정동의기출상행PABD。삼조2013년미국가주위산기출혈고위분류림상표준，장PABD잉부분위저위조、중위조급고위조。관찰잉부채혈전후혈상규、혈압、심솔、말소혈양포화도급기타불량반응변화정황，전자태심감호관찰태심변화，분석잉부행PABD적안전성，병평고각조산시출혈량、자체혈회수정황급분면결국。결과92례접수PABD적잉부공채혈115례차。저위조、중위조화고위조산전비혈량중위수분별위300、300급400 mL。115례차잉부채혈후5 min서장압교채혈개시시평균하강3．4 mmHg，차이유통계학의의（P＜0．05）；채혈결속시반영감측생명정변화적삼수차이무통계학의의（P＞0．05）；태심감호전부위반응형。 PABD잉부단차채혈후혈홍단백화홍세포압적（hematocrit， HCT）교채혈전평균강저5．4％화2．1％，차이균유통계학의의（P＜0．05），분면전균회복지채혈전수평。2차행PABD적잉부혈홍단백화HCT변화여단차채혈유사，단제2차채혈후혈홍단백、HCT여채혈전상비차이무통계학의의（ P＞0．05）。소유잉부분면후무신생인질식화위산인사망。결론 PABD가위산부급시제공자체전혈。재엄격관리하，유지정지사용PABD기술구유합이성화안전성。
Objective Preoperative autologous blood donation ( PABD) may reduce the need for allogeneic blood , but it may also cause a short massive blood loss in pregnant women , and its fetal and maternal safety has to be adequately assessed .This study was to evaluate the feasibility and safety of PABD for pregnant women and their fetuses . Methods A prospective observational study was conducted among the women who met the inclusion criteria and gave birth in Nanjing Drum Tower Hospital between January and December 2013 .According to the clinical validation of risk stratification criteria for peripartum hemorrhage of California 2013 , the ca-ses were classified into a low-, a medium-, and a high-risk group.Data on blood donation procedures , obstetric outcomes, and blood transfusions were collected after delivery for analysis . Results Totally, 92 pregnant women accomplished 115 blood donations .The median volumes of the donated blood were 300, 300, and 400 mL in the low-, medium-, and high-risk groups, respectively ( P>0.001).There were no significant changes in HR , SBP and SpO2 during the blood donation procedures (P>0.05) except for the fall of diastolic blood pressure by an average of 3.4 mmHg (P<0.05) at 5 minutes after blood collection, which was restored to normal later.Non-reassuring fetal heart rate patterns were not found in any of the cases .The levels of HB and HCT were remarkably lower af-ter donation than before it (P<0.05) but restored to normal before delivery in the PABD cases who donated once only (P>0.05), which were similar to those in the cases who donated twice , with no significant differences before and after the donation (P>0.05). Homologous blood transfusion was performed for 5 cases (17.9%) in the high-risk group, with the volume of blood loss >2000 mL in all the cases.All the newborns survived without asphyxia and there was no perinatal death . Conclusion PABD can provide timely autologous whole blood donation for pregnant women .Under strict management , PABD is feasible and safe for pregnant patients who are at a high risk for massive blood loss during delivery or have a rare type of blood no readily available .