危重症早产低体重儿血液置换前后内环境变化

Changes of Blood Components in Imminent Low Weight Premature Undergone Exchange Transfusion

目的:探讨危重症早产低体重儿外周同步换血治疗前后血液内环境的改变及其原因。方法:对2003年1月至2004年12月在本科NICU住院21例次危重症早产低体重儿在外周同步换血过程中的血常规、凝血常规、生化及血气等指标进行测定并分析。结果:平均换血量:142.63ml/kg,平均换血速度:(65.00±8.43)ml/(kg·h)。换血前血清总胆红素P<0.01;直接胆红素无明显变化。总胆红素、间接胆红素和直接胆红素的换出率分别为:32.08%、31.27%和32.53%。患儿血白细胞和血小板明显下降(P<0.01);红细胞、血红蛋白无明显变化,P>0.05;凝血功能无显著性变化;换血后血钾降低较明显,P<0.05;钠、镁、钙无明显变化;血糖无明显变化;Bun换血后下降较明显,P<0.05。换血过程中发生心律失常、心衰各1例,发生率均为6.25%;换血成功率为87.50%。结论:换血术治疗危重症早产低体重儿可降低白细胞及血胆红素,减轻重症感染症状,有效治疗重症高胆红素血症;但换血后要注意防止出血,注意控制换血速度。

Objective： To investigate the changes of blood components in imminent low weight premature after and before synchronous exchange transfusion. Methods. 21 cases of imminent low birth weight premature infant in our NICU were treated by synchronous exchange transfusion. The blood routine, bleeding time test, some level of biochemical indices and blood gas were examined during treatment. The results after and before exchange transfusion were compared. Results： The mean blood exchange quantity was 142. 63ml/kg, the mean blood-exchange speed was （65.00±8. 43）（ml/kg· h）. Before blood-exchange, the total blood bilirubin and the indirect bilirubin were （353. 29±42. 98）μmol/L and（282. 50±26.66）μmol/L respectively; after blood exchange, their level were （239.96±22. 54）μmol/L, （194.15±15.07）μmol/L, P〈0. 01. No change of direct bilirubin. The exchange rate of total bilirubin, indirect and direct bilirubin was 32. 08%, 31.27%, and 32. 53% respectively. The WBC and platelet count were significantly decreased,P〈0. 01. The blood Potassium decreased significantly after exchange transfusion, P〈0. 05. The success rate of exchange transfusion was 87. 50%. Conclusions： The synchronous exchange transfusion for treatment of imminent low birth weight premature infant can efficiently prevent infection and treat severe hyperbilirubinemia but the complication, such as bleeding, should be prevented.