探讨在凶险性前置胎盘(pernicious placenta previa)高危孕产妇剖宫产术分娩中发生大出血时，应用术中回收式自体输血(IOCS)技术的可行性及安全性。

选取2016年7月至2017年5月，于四川大学华西第二医院产科采取剖宫产术分娩发生大出血时，接受IOCS技术治疗的凶险性前置胎盘孕产妇64例为研究对象。对本组64例孕产妇剖宫产术前和术后相关血液学指标比较，采用配对t检验。观察其IOCS的自体血液回输量、输血治疗不良反应发生情况及妊娠结局。本研究遵循的程序符合四川大学华西第二医院医学伦理委员会所制定的伦理学标准，得到该委员会批准(审批文号：2013伦理批第39号)。本研究征得孕产妇本人及其家属的知情同意，并且与其签署《自愿接受回收式自体输血治疗知情同意书》。

①术后与术前相关血液学指标比较：本组64例采取剖宫产术分娩发生大出血孕产妇在剖宫产术后，血常规检测结果显示，红细胞计数、血红蛋白(Hb)水平、血细胞比容(HCT)、血小板计数，均较术前显著降低，并且差异均有统计学差异(t＝9.25、9.66、9.64、6.95，均为P<0.001)。其凝血功能检测结果显示，凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)，均较术前显著延长，而纤维蛋白原(Fib)水平，则较术前显著降低，差异亦均有统计学意义(t＝－3.75、－4.16、4.20，P＝0.001、<0.001、<0.001)；肝、肾功能检测结果显示，天冬氨酸氨基转移酶(AST)水平、肌酐浓度，均较术前显著升高，而总蛋白、白蛋白、球蛋白水平及尿素氮浓度，则均较术前显著降低，术后与术前比较，差异均有统计学意义(t＝－2.38、－2.07、14.96、10.72、11.89、2.13，P＝0.024、＝0.048、<0.001、<0.001、<0.001、＝0.042)，但是均在正常参考值范围内。②自体血液回输量：本组64例孕产妇剖宫产术中，采取IOCS的自体血液回输量为650 mL(200～1 350 mL)。③不良反应：本组64例孕产妇均未发生发热、蛋白尿、凝血功能异常等输血不良反应。④妊娠结局：本组64例孕产妇分娩的64例新生儿的生后1 min Apgar评分为(9.3±1.3)分，术后母儿情况良好，而且无一例新生儿发生不良妊娠结局。

采取IOCS技术治疗凶险性前置胎盘高危孕产妇剖宫产术分娩大出血，既可使孕产妇自身血液资源得到有效回收、利用，节约血液资源，亦可降低孕产妇发生异体输血不良反应风险，避免输注异体血液导致的传染性疾病，是一种经济、安全、有效的自体血液回收输血措施。对于IOCS技术是否值得在产科凶险性前置胎盘高危孕产妇的剖宫产术分娩发生大出血时推广应用，由于本研究样本量较小，而且没有设置对照进行研究，因此尚需多中心、大样本、随机对照试验进一步研究、证实。

To investigate the feasibility and safety of intraoperative cell salvage (IOCS) in caesarean section of pregnant women with high risk of pernicious placenta previa.

A total of 64 cases of pregnant women with pernicious placenta previa who underwent cesarean section with massive hemorrhage during operation and then received IOCS treatment in West China Second University Hospital, Sichuan University from July 2016 to May 2017 were selected as research subjects by retrospective method. The clinical data were collected on basic condition of the pregnant women and their newborns. The changes of hematological parameters before and after cesarean section among the 64 cases of pregnant women were compared by paired t test. The volumes of perioperative bleeding and autologous blood transfusion, adverse reactions caused by blood transfusion and pregnancy outcomes were observed. This study was approved by the Ethics Committee of Human Beings in West China Second University Hospital, Sichuan University (Approval No.2013-39). Informed consents were obtained from all the subjects and their family members, and Voluntary Consent for Recovery of Intraoperative Cell Salvage was signed with each of them.

①In the postoperative period, hematological parameters of red blood cell count, hemoglobin (Hb) level, hematocrit (HCT) and platelet count all were significantly lower than those of preoperative period, and all the differences were statistically significant (t=9.25, 9.66, 9.64, 6.95; all P<0.001). The coagulation function indicators including prothrombin time (PT), activated partial thromboplastin time (APTT) after operation both were longer than those before operation, while fibrinogen (Fib) level was lower than that before operation, and all the differences were statistically significant (t=-3.75, P=0.001; t=-4.16, P<0.001; t=4.20, P<0.001). In the postoperative period, biochemical indexes of liver and kidney functions, level of aspartate aminotransferase (AST) and concentration of creatinine were higher than those in preoperative period, while levels of total protein, albumin, globin and urea were lower than those in preoperative period, and all the differences were statistically significant (t=-2.38, P=0.024; t=-2.07, P=0.048; t=14.96, P<0.001; t=10.72, P<0.001; t=11.89, P<0.001; t=2.13, P=0.042). Levels of all the biochemical indexes mentioned above were within normal reference ranges during perioperative period. ②The amount of blood salvage and reinfusion by IOCS treatment strategy among 64 patients was 650 mL (200-1 350 mL). ③There were no adverse reactions caused by both blood salvage and reinfusion and allogeneic blood transfusion such as fever, hemoglobinuria and coagulation abnormalities in 64 pregnant women in this study. ④The 1 min Apgar score after birth of the 64 neonates was (9.3±1.3) scores. Postoperative maternal conditions were good and no adverse outcome occurred in neonates.

Adopting IOCS technology to treat massive hemorrhage during cesarean section of pregnant women with high-risk of pernicious placenta previa, can effectively recycle the blood and reduce the amount and proportion of allogeneic blood transfusion during cesarean section. It can also decrease the risk of postoperative transfusion reactions and avoid the infective diseases of allogeneic blood transfusion, so IOCS technology is an economical, safe and effective autologous blood recovery and transfusion measure. Because the sample size of this study is relatively small and pregnant women in control group are not enrolled, whether the IOCS technology is worthy of promotion and application in the cesarean section of pregnant women with high-risk of pernicious placenta previa, it still needs to be further studied and confirmed by multi-center, large-sample, randomized controlled trials.