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目的:探讨洗涤式自体血回输在异位妊娠大出血术中的应用价值。方法:将63例异位妊娠伴腹腔内出血的患者分为2组,以愿意采用自体输血方式并符合自体血回输纳入标准的35例患者为自体输血组,其余28例患者作为对照组。观察2组术中出血、输血及不良反应情况;监测自体输血组术前和术后24h血红蛋白(Hb)、血细胞比容(HCT)、白细胞(WBC)、血小板(PLT)、纤维蛋白原(Fib)、凝血酶原时间(PT)、氧分压(PaO2)变化;比较2组伤口拆线时间、住院时间、术后β-HCG水平恢复时间及预后。结果:1自体输血组术中回收血量为1 106±480ml/例,洗涤后回输血量为980±465ml/例,回输自体血后未出现蛋白尿、发热、呼吸困难等不良反应,术中术后均未输库存血;2自体输血组术后24h的Hb、HCT及WBC较术前明显下降(P<0.05),而PaO2较术前明显升高(P<0.05)。PLT术后明显下降(P<0.05),但在正常范围内。3自体输血组伤口拆线时间和住院时间明显少于对照组(P<0.05),术后β-HCG水平恢复时差异无统计学意义(P<0.05)。2组患者术后24h及72h随访时均未出现明显的感染,术后身体恢复情况良好。结论:采用洗涤式血液回收机对异位妊娠内出血较多的患者进行自体血回输,及时安全有效,具有重要的临床应用价值。
Objective: To investigate the value of wash-type autologous blood transfusion in the surgical treatment of ectopic pregnancy bleeding. Methods: Sixty-three patients with ectopic pregnancy and intraperitoneal hemorrhage were divided into two groups. The 35 patients who were willing to adopt autologous blood transfusion and met the criteria of autologous blood transfusion were self-transfusion group, and the remaining 28 patients were used as control group. The blood loss, blood transfusion and adverse reactions were observed in two groups. The levels of hemoglobin (Hb), hematocrit (HCT), white blood cells (WBC), platelets (PLT), fibrinogen ), Prothrombin time (PT) and partial pressure of oxygen (PaO2). The time of stitches removal, length of stay, postoperative β-HCG recovery time and prognosis were compared between the two groups. Results: 1 The autologous blood transfusion group had a blood volume of 1 106 ± 480ml per case and a transfusion volume of 980 ± 465ml / case after washing. There was no proteinuria, fever, dyspnea and other adverse reactions after autologous blood transfusion (2) The Hb, HCT and WBC in autologous blood transfusion group were significantly lower than those before operation (P <0.05), while PaO2 was significantly higher than that before operation (P <0.05). After PLT decreased significantly (P <0.05), but within the normal range. The time of stitches removal and hospital stay in the autologous blood transfusion group were significantly less than those in the control group (P <0.05). There was no significant difference in postoperative β-HCG recovery between the two groups (P <0.05). No significant infection was found in the two groups at 24h and 72h after operation, and the body recovered well after operation. Conclusion: It is safe and effective to use the washing blood recovery machine to transfuse autologous blood in patients with more bleeding during ectopic pregnancy, which has important clinical value.