新生儿换血术后血生化代谢的变化规律探讨

Investigation of biochemistry metabolism after total exchage transfusion in neonates

目的 探讨全部换血术对败血症、高胆红素血症的新生儿血气、电解质、生化代谢的影响。方法 检测 37例次新生儿换血前后的血气、电解质、生化代谢指标并进行分析比较。结果 血清钠、血清钙与血浆渗透压换血前后比较差异显著 (P <0 0 5 )。换血术后纠正低钠血症 8例 ,高钠血症 1例 ;纠正低血浆渗透压 11例 ,高血浆渗透压 1例 ;纠正低钙血症 5例 ,新增低钙血症 5例。低钾血症 15例 ,术后未完全纠正 ,新增 1例低钾血症。纠正高血糖 5例 ,新增 6例高血糖。无低血糖或高钙血症发生。术后胆红素、尿素、肌酐及C反应蛋白均明显降低。结论 在适当的呼吸支持下 ,采用新鲜枸橼酸抗凝血 (72h内 )换血治疗 ,对新生儿血气酸碱平衡、心、肝、肾等重要器官的影响较小。严密监测血电解质及血糖 ,及时处理低钙、低钾血症和高血糖症 。

Objective To investigate effects caused by total exchange transfusion on blood gas,electrolyte,and biochemistry metabolism in the neonate with septemia or hyperbilirubinemia.Methods To check the blood gas analysis,electrolyte and some biochemistry findings of neonates before and after exchange transfusion in 37 cases and then to study the effects.Results Differences are significant at the level of serum sdium,serum calcium and plasma osmolality before and after exchange transfusion.(P<0.05).After exchange transfusion,8 cases of hyponatremia became normal,1 case of hypernatremia was corrected.11 cases of hyposmolality was corrected after exchange;1 case with hyperosmolality was corrected after exchange;5 cases of hypocalcemia were corrected but after that 5 new cases of hypocalcemia were noted.There were 15 cases of hypokalemia which could not be corrected completely after exchange transfusion,and 1 new case of hypokalemia was found.5 cases of hyperglycemia were corrected after that,and 6 new cases of hyperglycemia were noted.No case of hypoglycemia or hypercalcemia was found.The level of bilirubin,urea,creatinine and CRP were decreased after exchange transfusion on average.Conclusion Under adequated respiratory support,exchange transfusion for the neonate with fresh citrate anticoagulation(<72?h)can make influence less to the blood gas balance and also to the heart,liver and renal,we should monitor the level of blood eletrolyte and glucose,especially we should pay attention to hypocalcemia,hypokalemia and hyperglucose and correct them immediately,which helps the neonate through the high-risk stage.