[Evaluation the application of intra-operative cell salvage in cesarean section based on multicenter data].

Objective: To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section. Methods: A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression. Results: (1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years (OR=1.5, 95%CI: 1.1-1.9), prenatal hemoglobin level <110 g/L (OR=1.7, 95%CI: 1.3-2.2), history of uterine surgery (OR=1.8, 95%CI: 1.3-2.6), placenta previa (OR=1.9, 95%CI: 1.1-3.1), placenta accreta (OR=2.6, 95%CI: 1.8-3.9), blood pool in the placenta (OR=1.6, 95%CI: 1.1-2.3), abnormal posterior placenta muscle wall (OR=1.8, 95%CI: 1.2-2.6), placenta projecting to the anterior uterine wall (OR=3.0, 95%CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion: IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.目的： 探讨回收式自体血回输（IOCS）技术在剖宫产术中应用的安全性、有效性及应用指征。 方法： 收集2016年8月—2019年1月全国11家三级甲等医院剖宫产术中应用IOCS技术输血的产妇共1 265例，根据剖宫产术中出血量分为<1 500 ml组（796例）和≥1 500 ml组（469例）。回顾性分析产妇及新生儿的一般临床资料、超声检查征象、围产期及产褥期指标；应用logistic多因素回归模型分析影响产妇术中出血量≥1 500 ml的危险因素。 结果： （1）1 265例应用IOCS技术输血的产妇总回收血量共848 001 ml，回输血量共418 649 ml，相当于23 258 U红细胞悬液，极大地节约了医疗资源。（2）<1 500 ml组和≥1 500 ml组的中位术中出血量分别为800 ml （300~1 453 ml）和2 335 ml （1 500~20 000 ml）。两组产妇均无羊水栓塞、严重输血不良反应、休克、死亡发生。（3）多因素分析显示，年龄≥35岁（OR=1.5，95%CI为1.1~1.9）、产前血红蛋白水平<110 g/L（OR=1.7，95%CI为1.3~2.2）、子宫手术史（OR=1.8，95%CI为1.3~2.6）、前置胎盘（OR=1.9，95%CI为1.1~3.1）、胎盘植入（OR=2.6，95%CI为1.8~3.9）、胎盘内存在血池（OR=1.6，95%CI为1.1~2.3）、胎盘后肌壁异常（OR=1.8，95%CI为1.2~2.6）、胎盘凸向子宫前壁（OR=3.0，95%CI为1.3~7.0）是显著影响产妇术中出血量≥1 500 ml的危险因素（P均<0.05）。 结论： IOCS技术输血在剖宫产术中应用相对安全、有效，节约了医疗资源，但需要严格规范其应用指征。.