新生儿无肝素外周双管同步换血疗法的可行性研究

Effect of Exchange Transfusion via Peripheral Blood Vessels Without Heparin for Neonates with Hyperbilirubinemia

目的探讨无肝素外周双管同步换血疗法治疗新生儿高胆红素血症的可行性。方法将60例高胆红素血症符合换血指征的新生儿随机分为无肝素组(32例)和肝素组(28例)。无肝素组将作为输出途径的动脉穿刺置管不连接肝素帽、三通活塞管及延长管,直接接10ml注射器抽血;建立静脉通路以换血,整个换血过程无肝素抗凝。肝素组将作为输出途径的动脉穿刺置管接三通活塞管,三通活塞管另外两端,一端接肝素氯化钠溶液,一端接输液延长管后接10ml注射器抽血,每抽出20ml动脉血,经三通活塞管注入2ml肝素氯化钠溶液。结果无肝素组血总胆红素换出率(51.87±8.74)%,肝素组(48.48±12.55)%,两组比较,差异无显著性意义(P>0.05)。换血后两组总胆红素、间接胆红素显著下降(均P<0.01);两组血常规、血糖、血电解质、生命体征等观察指标比较,差异无显著性意义(均P>0.05);两组换血后血小板、血糖、血钾与换血前比较,差异有显著性意义(均P<0.01);肝素组出血并发症发生率14.29%,无肝素组无出血并发症,两组比较,差异有显著性意义(P<0.05)。结论无肝素外周双管同步换血疗法与肝素外周双管同步换血疗法同样安全有效,且可最大限度地避免传统的肝素外周双管同步换血疗法可能带来的出血并发症;但同样可引起血小板减少、血糖升高及血钾降低。

Objective To explore the possibility of the transfusion exchanging via Peripheral Blood Vessels without heparin in the treatment of new-borns with hyperbilirubinemia. Methods Sixty newborns with hyperbilirubinemia were randomly divided into two groups as follows： the non-heparin group （32 cases） and the heparin group （28 cases）. In nonheparin group, injection syringe of 10 ml was connected to the arteriopuncture ductus directly without heparin cap, three-way stopcock ductus and the extending ductus, and during the transfusion exchanging, heparin was not applied t for anticoagulation. In the heparin group, the three-way stopcock ductus was connected to the arteriopuncture ductus, and another two tips were connec-ted the ductus for heparin infusion and the injection syringe of 10 ml for hemospasia. During the transfusion exchanging, 2 ml heparin saline was applied via the three-way stopcock ductus in case of blood coagulation after every 20 ml blood drawing. Results Total bilirubin and indirect bilirubin were decreased significantly in both groups after transfusion exchanging （P〈0.01 for all）, while no difference was found between the two groups when comparing the clearance rate of the total bilirubin in the blood （P〉0. 05）[（51. 87 ±8.74）% in non-heparin group vs （48.48±12.55）% in he-parin group）]. There ware no differences in some indexes between the two groups such as the blood routine, blood glucose, blood electrolyte and the vital signs（P〉0.05 for all）, while platelet, blood glucose, potassium showed significant differences before and after the exchange transfusion in both groups （P〈0.01 for all）. Four cases （14.29 %） in the heparin group developed the hemorrhage while none in the non-heparin group, showing significant difference（P〈0.05）. Conclusion The transfusion exchanging without heparin was as effective as that with heparin, and safer because of less complications such as the hemorrhage; but it also leads to decreasing platelets and concentration of patassium and raising blood glucose.