外周动静脉同步换血法治疗重症新生儿高胆红素血症效果观察

Effect of synchronous exchange transfusion of peripheral artery and vein in neonates with severe hyperbilirubinemia

[目的 ]观察外周动静脉同步换血法治疗重症新生儿高胆红素血症的疗效。 [方法 ]对 6例重症高胆红素血症患儿采用了外周动静脉同步换血疗法。外周静脉输血 ,输液泵控制速度 2 0 0ml/h～ 3 0 0ml/h ,外周动脉抽血速度参照输入速度。换血前后行血常规、血生化、肝功能、血培养等检查 ;以多功能监护仪监测心率、呼吸、血压、体温 ;随诊10个月至 2a ,观察有无胆红素脑病后遗症表现。 [结果 ] 6例患儿血清总胆红素在换血前 ( 844 .0 7±3 14 .3 4) μmol/L ,换血后 ( 4 0 8.2 7±160 .40 ) μmol/L ,换血前后差异有统计学意义 (P <0 .0 1) ,总胆红素换出率为 5 1.3 3 % ,换血后白细胞、血清钾、氯略有下降 ,血清钙略为上升 ,其余生化指标均无变化 ,换血前后血培养均为阴性 ,生命体征稳定 ;追踪观察 ,1例出现胆红素脑病后遗症表现 ,其余 5例发育正常。 [结论 ]外周动静脉同步换血法具有实用、易行、安全、并发症少等优点 ,是治疗重症新生儿高胆红素血症的有效方法。

Objective:to observe the effect of synchronous exchange transfusion of peripheral artery and vein to treat neonates with severe hyperbilirubinemia. Method: a total of 6 cases with severe hyperbilirubinemia were accepted synchronous exchange transfusion of peripheral artery and vein, that is, peripheral vein blood transfusion, velocity of transfusion controlled via pump at 200 ml/h-300 ml/h, the speed of hemospasia from peripheral artery were kept at same with transfusion velocity. Examinations such as blood routine, blood biochemistry, liver function, hemoculture of patients were performed before and after the transfusion. Vital signs including heart rate, respiration, blood pressure and body temperature of neonates were monitored via multi-functional monitoring system before and after exchange transfusion. Patients were followed up for 10 months-2 years to observe the occurrence of sequela of bilirubin encephalopathy. Result: there was a significant difference in serum total bilirubin before and after exchange transfusion, for serum total bilirubin in 6 patients was 844.07±314.34 μmol/L before exchange transfusion and 408.27±160.40 μmol/L after transfusion respectively. Total bilirubin shift-out rate was 51.33%. WBC of patients was decreased. And serum potassium and chloride concentration of patients were also decreased a little. Except that serum calcium of neonates increased a little. However, there was no change in other biochemical indexes. Blood culture of patients either before or after exchange transfusion was negative. Vital signs of all cases were stable after exchange transfusion. Only one case developed sequela of bilirubin encephalopathy. The other 5 cases were with normal growth and development based on data of followed-up. Conclusion: synchronous exchange transfusion of peripheral artery and vein is practicable, simple and safe with few complications, which is an effective method in the treatment of neonate with severe hyperbilirubinemia.