| ObjectiveDangerous type of placenta previa (PPP) refers to the previous history of cesarean section for placenta previa and the placenta attached to the pregnancy uterine scar area, often accompanied by placenta increta. It can lead to occurs uncontrollable bleeding during perioperative,the safety of mothers and babies have a significant impact, easy to refractory postpartum hemorrhage and thus life-threatening. In recent years, with the rising rate of cesarean section, the incidence of dangerous placenta previa is also increasing, especially with the release of China’s second child policy,the aging of the dangerous pre-placenta can not be ignored,it easily leads to hysterectomy and postpartum hemorrhage, should be subject to obstetrics,anesthesiologists highly concerned.In the multidisciplinary joint treatment of dangerous placenta previa placenta maternal bleeding, blood transfusion is the key to success, but shortage of blood resources is a worldwide problem by far,and the current study shows that there are many problems with allogeneic blood transfusion. With the progress of science and technology, the study found that intraoperative cell salvage is an effective blood protection measures. It has been widely used in various clinical departments. But concerning of the amniotic fluid contamination and maternal fetal hemolysis, it has always been considered as contraindication in obstetrics. With the progress of blood doping technique and the use of leukocyte filtration device,it has being used in obstetrics on recent two decades.Autologous blood after filtration and washing, can make a lot of plasma protein,coagulation factors, platelets arid other coagulation components are lost, may cause the body coagulation dysfunction. Whether with the thrombelastography(TEG)applied to a large number of patients with blood transfusion worthy of study,TEG is a coagulant function testing instrument, which was invented by the German Harret in 1948. It simulates blood coagulation and fibrinolysis in the human body by physical,can quickly determine whether patients exist hypercoagulable, low coagulation,fibrinolysis hyperthyroidism, and analyze the reasons of it.TEG achieves coagulation factor initiation, platelet aggregation, fibrinolytic dynamic monitoring, providing patients with true coagulation. It was widely used in clinical guidance of intraoperative blood transfusion and achieved good results in 1980. In China, it was used in 2000 to guide the use of intraoperative blood transfusion and coagulation-related drugs, and in 2006 formally incorporated into the objective basis for clinical selection of blood products. Studies have suggested that TEG can respond to the functional status of various blood components, rapid detection the blood coagulation function effect of autologous blood transfusion in maternal, clear which blood components is lacking, to guide intraoperative composition blood transfusion,so that the greatest benefit of maternal, and can prevent clinical use Blood is blind and wasteful.Materials and MethodsThirty patients with Pernicious placenta previa were selected. In obstetrics,anesthesiology, interventional radiology, blood transfusion combined with cesarean section, intraoperative anesthesia management was performed according to the established risk of placenta anesthesia management procedure. The condition was followed by the program. Intraoperative blood salvage is scheduled for use when intraoperative bleeding is estimated more than 800 ml. The use of the United States Cell Saver 5 + autologous blood recovery machine recycle blood from operative field after the fetus and placenta delivered and Amniotic fluid composition cleaned.Through the treatment of anticoagulant, centrifugal, cleaning and purification,concentrated red blood Cell is forming, and return to the patients during surgery.Respectively , collecting blood 3-5 ml with sodium citrate anticoagulation via central venous when preoperative and postoperative,15 minutes to 2 hours after taking blood by .the person according to the rules of operation for TEG assay analysis. The changes of blood gas analysis .(hemoglobin) and TEG were observed before and after transfusion, and the adverse reactions were observed.ResultsThe final 25 patients were included in the study, patients with vital signs were stable,the amount of bleeding 1000-3000ml, were receiving self-transfusion transfusion,blood transfusion 250-1000ml, 1 case of RH (-) blood, the operation time 60-210min,of which 5 patients were treated with interventiopal technique to reduce intraoperative bleeding. Fifteen patients underwent intraoperative combined with allogeneic blood and frozen plasma, which were suspended in red blood cells 1.5-6U and frozen plasma 300-700ml. Five patients were given cold Precipitation 10.5u,fibrinogen 2g,of which 2 cases also gave aminocarbamic acid 4g. 6 patients with cesarean section combined with hysterectomy. 2 patients with mild to moderate ARDS; 2 patients with postoperative infection; no amniotic fluid embolism clinical manifestations and DIC,intestinal obstruction occurred. The changes of TEG (K, Angle, MA) P> 0.05, R value:P = 0.01,but R value changes in the normal range, so the autologous blood transfusion in patients with coagulation no effect.Conclusions1、25 patients underwent autologous blood transfusion, were not happened the clinical symptoms of amniotic fluid embolism, no patients death after surgery due to autologous blood transfusion. Intraoperative autologous blood transfusion provides a new way for the RH (-) maternal and Christian maternal blood transfusion.2、In the obstetric bleeding, the use of intraoperative autologous blood, platelets, cold precipitation, blood frozen plasma, fibrinogen, tranexamic acid can improve the patient’s coagulation function, improve patient prognosis.3、TEG through the various parameters (R, K, Angle, MA) quickly reflect the whole picture of coagulation, to guide the specific blood transfusion program to evaluate the recovery of autologous blood transfusion on maternal coagulation function, is clinically reliable coagulation. monitoring technology. |
PDF Full Text Request