中国妇产医院剖宫产分娩过程中靶向细胞回收输血与输注同种异体红细胞之间的相关性研究
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The Association of Targeted Cell Salvage Blood Transfusion During Cesarean Delivery With Allogeneic Packed Red Blood Cell Transfusions in a Maternity Hospital in China
背景与目的：术中自体输血可以减少剖宫产术后异体红细胞输血。本研究评估了在出血风险增加的妇女剖宫产术中有针对性的术中靶向细胞回收输血的实施。
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方法：所有接受剖宫产术且妊娠>28周的妇女均纳入本研究。术前细胞收集期（2010-10-1至2012-8-31，共11322例）与实施后的时期（2012-9-1至2015-6-30，共17,456例）使用中断时间序列分析。在实施后的时期，需要输血的妇女在术中进行细胞收集。主要结果是同种异体红细胞的月使用率和急性输血反应的临床表现的发生率。
结果：经过57个月的研究，存在术中靶向细胞回收输血者的每月异体血细胞输注率均数（标准差）为2.2％±0.7％；不存在术中靶向细胞回收输血者，每月异体血细胞输注率均数（标准差）为2.7％±0.9％（95％CI，-1.4％-0.3％，P=0.22）。未实施术中靶向细胞回收输血者，输注同种异体细胞平均为4.1±0.4单位，实施术中靶向细胞回收输血者为3.9±0.9单位（差异为0.2，95％CI，-1.7-1.1单位，P=0.69）。757例（47％）存在术中细胞回收，847例（53％）不存在术中细胞回收，术中细胞回收的术中异体红细胞月使用率较低（差异为0.7％，95％CI，-0.1％-1.4％，P = 0.03），但术后同种异体红细胞的月使用率无变化（差异-0.2％，95％CI，-0.4％-0.7％,P=.56）。急性输血反应的临床表现发生率组间无变化（差异2％，99％CI，-9％-5％，P =.55）。
结论：我们的研究结果表明，在妇女接受剖宫产手术中，有针对性的靶向细胞回收输血可减少术中同种异体红细胞月使用率，但不减少术后同种异体红细胞的月使用率。术中靶向细胞回收输血在剖宫产术中的应用与住院期间较少的同种异体红细胞使用无关。术中靶向细胞回收输血相关的不良事件较少，支持剖宫产术中靶向细胞回收输血的安全性。
Haiya Yan, MD,Ling-Qun Hu, MD，Yun Wu, MD, MS,et al.The Association of Targeted Cell Salvage Blood Transfusion During Cesarean Delivery With Allogeneic Packed Red Blood Cell Transfusions in a Maternity Hospital in China.
Anesth Analg.2018.
BACKGROUND:Autologous transfusion of intraoperative cell salvage blood may be a potential method to decrease the need for allogeneic packed red blood cell transfusions after cesarean delivery,although there are limited data on the benefits of this method.This study evaluated the implementation of targeted intraoperative cell salvage during cesarean delivery in women at increased risk for hemorrhage at the Women’s and Children’s Hospital in Ningbo,China.
METHODS:All women who underwent cesarean delivery>28 weeks of gestation were included in the study.The period before intraoperative cell collection(October 1,2010,to August 31,2012,n=11,322) was compared with the postimplementation period (September 1,2012,to June 30,2015,n=17,456)using an interrupted time series analysis.In the postimplementation period,women suspected to be at increased risk of the need for a blood transfusion(1604,9.2%)underwent intraoperative cell salvage collection.The primary outcomes were the monthly rate of allogeneic packed red blood cell use and the incidence of clinical manifestation of acute blood transfusion reactions.
RESULTS:The mean (standard deviation) estimated monthly allogeneic packed blood cell transfusion rate at the end of the 57-month study was 2.2%±0.7% with the implementation compared with 2.7%±0.9% without, difference−0.5%,95% CI,-1.4% to 0.3%;P=.22.The mean number of allogeneic units transfused per patient was 4.1±0.4 units with implementation and 3.9±0.9 units without,difference 0.2,95% CI,−1.7 to 1.1 units;P =.69.Intraoperative cell salvage blood was reinfused in 757(47%) and wasted in 847(53%) cases.The monthly intraoperative allogeneic packed red blood cells use rate was lower after implementation (difference−0.7%, 95%CI,−0.1% to−1.4%;P=.03);however,the monthly postpartum allogeneic packed red blood cell use rate was unchanged (difference−0.2%,95%CI,−0.4% to 0.7%; P=.56).The clinical manifestation of acute blood transfusion reactions rate was unchanged (difference−2%,99%CI,−9% to 5%; P=.55) between the periods.
CONCLUSIONS:Our findings suggest that targeted intraoperative cell salvage in women undergoing cesarean delivery was associated with less allogeneic blood exposure in the operating room,but not in the postoperative period.Intraoperative cell salvage in targeted cesarean deliveries was not associated with a lesser allogeneic red blood cell exposure over the hospital admission period.The lack of adverse events associated with intraoperative cell salvage supports the safety of intraoperative cell salvage in cesarean delivery.
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