剖宫产术中输血流行病学调查以及术中大量输血影响因素分析-现代医学

剖宫产术中输血流行病学调查以及术中大量输血影响因素分析

单位：联勤保障部队第九○九医院妇产科, 福建漳州 363000

分类号：R719.8

出版年·卷·期（页码）：2022·50·第六期（705-711）

摘要：

目的：研究某三甲医院剖宫产产妇并发症和术中输血情况，并探讨术中大量输血的影响因素。方法：回顾性分析2017年至2020年我院术中输血的剖宫产产妇，比较不同年度间剖宫产产妇输血率、年龄构成、孕周、体质指数(BMI)等临床资料和并发症的差异。根据输注红细胞(RBC)是否≥10 U，将所有术中输血产妇分为大量输血组和非大量输血组，分析术中大量输血的影响因素。结果：2017年至2020年间剖宫产产妇共4 990例，其中335例术中输血，输血率为6.71%，四年间输血率呈V字形波动，2017、2018年输血率明显高于2019年，差异有统计学意义(P＜0.05)。4年间因前置胎盘、贫血、先兆子痫和妊娠急性脂肪肝引起术中输血的发生率波动较小，差异无统计学意义(均P＞0.05)。不同年份小剂量RBC (＜10 U)输注占比均超过50%，但不同年度RBC输注量占比差异无统计学意义(P＞0.05)。术中大量输血组年龄、既往剖宫产手术史占比、凶险前置胎盘占比、凝血功能低下占比均高于非大量输血组，单胎占比低于非大量输血组，差异均有统计学意义(均P＜0.05)。二元Logistic回归显示，年龄、剖宫产史、凶险前置胎盘、多胎妊娠、凝血功能低下均为术中大量输血的独立影响因素。不同年度间大量出血产妇氨甲环酸使用率呈逐年增加的趋势，2017年和2020年间以及2018年和2020年间术后血红蛋白差异有统计学意义(均P＞0.05)。结论：2017年至2020年剖宫产术中输血病例数呈减少趋势，但输血率呈V字形波动，年龄、剖宫产史、凶险前置胎盘、多胎妊娠、凝血功能低下均为术中大量输血的独立影响因素。

Objective: To study the complications and intraoperative blood transfusion status of cesarean section in a tertiary hospital, and to explore the influencing factors of massive intraoperative blood transfusion. Methods: Retrospective analysis of cesarean section maternal blood transfusion in our hospital from 2017 to 2020. The blood transfusion rate, age, gestational age, body mass index(BMI) and complications were compared between different years. According to whether the transfusion of red blood cell(RBC) was more than 10 U, all the patients were divided into massive transfusion group and non massive transfusion group. Results: From 2017 to 2020, there were 4 990 cases of cesarean section, of which 335 cases received intraoperative blood transfusion, and the blood transfusion rate was 6.71%. The blood transfusion rate fluctuated in a V-shape in four years. The blood transfusion rate in 2017 and 2018 was significantly higher than that in 2019, and the difference was statistically significant(P<0.05). During the four years, the blood transfusion rate caused by placenta previa, anemia, preeclampsia and acute fatty liver of pregnancy fluctuated little, and the difference was not statistically significant(all P>0.05). The proportion of low-dose RBC(<10 U) transfusion in different years was more than 50%, but there was no significant difference in the proportion of RBC transfusion in different years(P>0.05). The proportion of age, previous cesarean section history, pernicious placenta previa and low coagulation function in the massive transfusion group were higher than those in the non massive transfusion group, and the proportion of singleton was lower than that in the non massive transfusion group, the differences were statistically significant(all P<0.05). Binary Logistic regression showed that age, history of cesarean section, pernicious placenta previa, multiple pregnancy and low coagulation function were independent factors of massive blood transfusion. The utilization rate of tranexamic acid in pregnant women with massive bleeding in different years showed an increasing trend year by year, and there was significant difference in postoperative hemoglobin between 2017 and 2020 and between 2018 and 2020(all P>0.05). Conclusion: In the past four years, the number of blood transfusion cases during cesarean section showed a decreasing trend, but the blood transfusion rate fluctuated in a V-shape. Age, history of cesarean section, dangerous placenta previa, multiple pregnancy, and low coagulation function were all independent influencing factors of massive blood transfusion during cesarean section.

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