【摘要】 目的：探讨在有高危出血风险的孕产妇剖宫产术中实施回收式自体输血(IOCS)的有效性和安全性。方法：选取2018年6月-2021年3月广州医科大学附属第六医院收治的75例有高危出血风险的孕妇行剖宫产分娩，根据输血方式不同分为试验组(33例)和对照组(42例)。试验组在剖宫产分娩过程中实施IOCS或伴有异体血输血，对照组在剖宫产过程中仅采用异体输血。比较使用不同输血模式的孕产妇的一般资料，以及手术24 h出血量、输注异体血液成分、术前术后血常规、凝血功能和输血不良反应的发生率。结果：试验组的胎盘植入比例、既往剖宫产次数要明显高于对照组(P<0.05)。试验组33例中手术24 h出血量>2 000 ml有16例，对照组42例中手术24 h出血量>2 000 ml有12例，试验组的手术24 h出血量>2 000 ml的比例要高于对照组。当两组手术24 h出血量≤2 000 ml时，试验组输入异体红细胞、血浆要少于对照组，差异有统计学意义(P<0.05)，输入冷沉淀差异无统计学意义(P>0.05)。当两组手术24 h出血量>2 000 ml，输入异体红细胞、血浆、冷沉淀比较，差异无统计学意义(P>0.05)。试验组的红细胞计数、血红蛋白水平、血细胞比容术前-术后差值低于对照组，差异有统计学意义(P<0.05)。两组术前-术后的血小板计数差值、凝血功能及不良反应发生率比较，差异无统计学意义(P>0.05)。结论：对于有高危出血风险的孕产妇在分娩过程中实施IOCS可降低具有高危出血风险孕产妇异体血输入量，不会增加相关不良反应的发生，是一种安全性和有效性都有保障的自体血输血模式，值得临床推广。更多还原

【Abstract】 Objective:To investigate the efficacy and safety of intraoperative cell salvaged (IOCS) autotransfusion during cesarean section in pregnant women with high risk of bleeding.Method:A total of 75 pregnant women with high risk of bleeding admitted to the Sixth Affiliated Hospital of Guangzhou Medical University for caesarean section from June 2018 to March 2021 were selected and they were divided into test group (33 cases) and control group (42 cases) according to different blood transfusion methods.During the operation,the maternal in the test group received IOCS or allogeneic blood transfusion,while those in the control group received allogeneic blood transfusion.The general data,blood loss within 24 hours,components of allogeneic blood transfusion,preoperative and postoperative blood routine,coagulation function and incidence of transfusion adverse reactions were compared between the pregnant women with different blood transfusion modes.Result:More rate of placenta implantation and previous cesarean sections were found in the test group than the control group (P<0.05).Among the 33 patients in the test group,16 patients had blood loss >2 000 ml within 24 hours,and there were 12 cases with blood loss >2 000 ml within 24 hours in the control group.Besides,more rate of blood loss >2 000 ml within 24 hours were found in the test group.When the blood loss was ≤2 000 ml within 24 hours,transfusion of allogeneic red blood cells and plasma in the test group were less than those in the control group (P<0.05),but no significant difference in the input of cryoprecipitate (P>0.05).When the blood loss in 24 hours was more than 2 000 ml,there were no significant differences in transfusion of red blood cells,plasma and cryoprecipitate in all groups (P>0.05).The differences in the red blood cell count,hemoglobin level and hematocrit before and after operation in the test group were lower than those in the control group (P<0.05).There was no significant differences in platelet count before and after operation,coagulation function and incidence of adverse reactions between the two groups (P>0.05).Conclusion:The intraoperative salvaged autotransfusion can reduce the transfusion of allogeneic blood during cesarean section for pregnant women with high risk of bleeding,without increasing the occurrence of related adverse reactions.So it is a safe and effective autotransfusion method that is worthy of clinical promotion.更多还原