两种途径部分换血治疗新生儿红细胞增多症的对照研究及换血量探讨

Randomized controlled trial and explore of exchange transfusion volume in two way partial exchange transfusion for treatment of neonatal polycythaemia

目的:探讨两种不同途径(抽血-输液)部分换血(PET)治疗新生儿红细胞增多症(NP)的疗效及最佳换血量。方法:把60例需要部分换血治疗的NP患儿随机分为周围静脉-周围静脉途径30例和桡动脉-周围静脉途径30例。换血量根据病情轻、重分为4～10.9mL/kg和11～25mL/kg。结果:两种途径部分换血后红细胞压积(HCT)均显著下降,分别从换血前的0.67±0.03和0.66±0.03降至换血后24h的0.57±0.03和0.58±0.04,两组前后比较差异均有显著意义(P<0.01),两组间HCT比较差异无显著意义;两种不同换血量均可使NP患儿血化验指标恢复正常,不同程度疾病的换血量差异有显著性,重度红细胞增多症组换血量多于轻度组(P<0.01)。结论:周围静脉-周围静脉途径与桡动脉-周围静脉途径部分换血治疗NP均有效,且效果相同,周围静脉-周围静脉途径操作简便,临床上尤其是基层临床可采用此途径及时救治NP患儿。4～10.9mL/kg和11～25mL/kg换血量均可治愈NP患儿,疾病程度愈重换血量愈大。

Objective To explore the effect and the optimum exchange transfusion volume in two different way （draw blood-give infusion） partial exchange transfusion（PET） with neonatal polycythaemia. Methods Sixty neonates with polycythaemia were divided randomly into two groups： PET with surrounding vein-surrounding vein way group（n=30） and PET with radial artery-surrounding vein way group （n =30）. According to the serious degree of the disease, the exchange transfusion volume was divided into 4- 10. 9 mL/kg and 11-25 mL/kg. Results The HCT significandy declined at 24h after PET with either surrounding vein-surrounding vein way or radial artery-surrounding vein way compared with that before the treatment 0. 67±0. 03 vs 0. 57 ±0. 03; 0. 66 ±0. 03 vs 0.58±0.04, respectively, P 〈 0.01. There was no difference between the two groups. All subjects in our study recovered regardless the way applied for transfusion. According to the serious degree of the disease, there was significant difference in the exchange transfusion volume. The volume of heavy polycythaemia group was more than light group（ P 〈 0. 01） . Conclusion Both the surrounding vein-surrounding vein way and the radial artery-surrounding vein way are effective as the way of PET, and the effects are the same. The surrounding vein-surrounding vein is simple and convenient. It is promptly used to cure neonatal polycythaemia in the clinic work, especially grass roots clinic work. Both the exchange transfusion volume of 4-10. 9 mL/kg and 11-25 mL/kg can cure neonatal polycythaemia, the heavier the degree of the disease is the more the exchange transfusion volume needs.