CAJ | 학술논문

目的：评价剖宫产术中自体血回收的可靠性。方法选择术前超声和磁共振诊断为凶险型前置胎盘和∕或胎盘植入的剖宫产术患者15例，年龄20～35岁，体重55～75 kg，孕周≥36周，术中将术野出血和羊水一同收集到储血罐内，经过洗涤的回收血利用重力作用通过白细胞滤器进行过滤。采集胎儿娩出后的母体静脉血样、洗涤前血样、洗涤后血样和过滤后血样各20 ml，采用巴氏染色法检测胎儿鳞状上皮细胞计数，酶联免疫吸附法检测甲胎蛋白、组织因子、内皮素?1及组胺的浓度，酸洗脱染色法检测胎儿红细胞计数。结果与洗涤前血样比较，洗涤后血样组织因子浓度升高，胎儿鳞状上皮细胞计数、甲胎蛋白、内皮素?1的浓度和胎儿红细胞降低（ P＜0．05）；与洗涤后血样比较，过滤后血样胎儿鳞状上皮细胞计数、甲胎蛋白浓度和胎儿红细胞降低（ P＜0．05）；与母体静脉血样比较，过滤后血样组织因子浓度升高，胎儿鳞状上皮细胞计数、甲胎蛋白和内皮素?1的浓度降低（P＜0．05）。结论剖宫产术中回收的自体血可用于回输。
목적：평개부궁산술중자체혈회수적가고성。방법선택술전초성화자공진진단위흉험형전치태반화∕혹태반식입적부궁산술환자15례，년령20～35세，체중55～75 kg，잉주≥36주，술중장술야출혈화양수일동수집도저혈관내，경과세조적회수혈이용중력작용통과백세포려기진행과려。채집태인면출후적모체정맥혈양、세조전혈양、세조후혈양화과려후혈양각20 ml，채용파씨염색법검측태인린상상피세포계수，매련면역흡부법검측갑태단백、조직인자、내피소?1급조알적농도，산세탈염색법검측태인홍세포계수。결과여세조전혈양비교，세조후혈양조직인자농도승고，태인린상상피세포계수、갑태단백、내피소?1적농도화태인홍세포강저（ P＜0．05）；여세조후혈양비교，과려후혈양태인린상상피세포계수、갑태단백농도화태인홍세포강저（ P＜0．05）；여모체정맥혈양비교，과려후혈양조직인자농도승고，태인린상상피세포계수、갑태단백화내피소?1적농도강저（P＜0．05）。결론부궁산술중회수적자체혈가용우회수。
Objective To evaluate the reliability of autologous blood withdrawal during cesarean section. Methods Fifteen patients preoperatively diagnosed with pernicious placenta previa and∕or accrete by using ultrasound and magnetic resonance imaging, aged 20-35 yr, weighing 55-75 kg, at≥36 weeks of gestation, were enrolled in the study. Blood containing amniotic fluid from the surgical field was collected, and the washed blood was processed using cell?salvage machine and then filtered using a leukocyte depletion filter during cesarean section. The 20 ml blood samples collected included maternal central venous blood after delivery of fetus, unwashed blood, washed blood and filtered blood. The fetal squamous cells were counted using papanicolaou staining. The concentrations of a?fetoprotein, tissue factor, endothelin?1 and histamine were measured by enzyme linked immunosorbent assay. The fetal red blood cells were counted using the acid elution method and HE staining. Results Compared with unwashed samples, the tissue factor concentrations were significantly increased, and the fetal squamous cell count, concentrations of a?fetoprotein and endothelial?1, and fetal red blood cells were decreased in the washed samples. Compared with washed samples, the fetal squamous cell count, concentrations of a?fetoprotein and fetal red blood cells were significantly decreased in filtered samples. Compared with maternal venous blood samples, the tissue factor concentrations were significantly increased, and the fetal squamous cell count and concentrations of a?fetoprotein and endothelial?1 were decreased in filtered samples. Conclusion Autologous blood withdrawn during cesarean section can be used for reinfusion in cesarean section.