有创动脉压监测下换血治疗新生儿重度溶血病

A study on exanguinotransfusion for treatment of severe hemolytic disease of the newborn under invasive arterial pressure monitoring

目的探讨有创动脉压监测下新生儿全自动换血疗法的方法和效果。方法对18例重度高胆红素血症新生儿采用外周动静脉同步全自动换血疗法进行治疗，并进行有创动脉压监测。结果平均换血时间为150min，总胆红素换出率为48．7％，换血前后血电解质、血糖水平稳定，换血前后有创动脉压（9．52±0．64kPa、9．92±0．84kPa）、呼吸（42．30±8．70；K／min、39．50±8．60次／min）、心率（142．50±20．30次／min、136．30±18．40次／min）、血氧饱和度（97．50％±5．19％、98．70％±3．10％）无明显波动（均P〉0．05）。结论有创动脉压监测下全自动换血安全、方便、操作简单，是新生几外周血管自动换血中最重要的监测方法。

Objective To study method and therapeutic effect of automatic exchange transfusion for severe neonatal hemolystic disease under invasive arterial pressure monitoring. Methods 18 neonates with severe neonatal hyperbilirubinemia were treated with peripheral arteriovenous synchronized automatic exchange transfusion therapy under invasive arterial blood pressure monitoring. Results The average time of exchange transfusion was 150 min. and exchange rate of total bilirubin was 48.7%. Before and after exchange transfusion, blood electrolytes and blood sugar levels were stable. The invasive arterial blood pressure （9.52 ±0. 64 kPa vs 9.92 ±0.84kPa, P 〉 0.05 ）, respiration （42.30 ± 8.70 times/min vs 39.50± 8.60 times/min, P 〉 0. 05） and heart rate （ 142.50 ± 20.30 times/min vs 136.30± 18.40 times/min, P 〉0.05） and degree of blood oxygen saturation of the neonates （97.50% ±5.19% vs 98.70% ±3.10%, P 〉0.05） were not fluctuated significantly. Conclusion The automatic exchange transfusion under invasive arterial blood pressure monitoring is safe, convenient and easy to operate, and invasive arterial blood pressure monitoring is the most important monitoring method in automatic exchange transfusion from peripheral blood vessels for severe neonatal hemolystic disease.