新生儿高胆红素血症换血术前后血液内环境变化的研究

Study of internal environment of neonates with hyperbilirubinemia before and after blood exchange transfusion.

目的探讨应用换血术治疗新生儿高胆红素血症对血液内环境各项指标可能造成的变化。方法对35例确诊为高胆红素血症新生儿采用外周动静脉同步换血术。使用同型全血，平均换血量为（136．9±27．4）ml／kg。换血速度为92ml／（kg·h），换血前后监测胆红素、电解质、血常规、血糖。结果换血后总胆红素换出率为53．78％，换血前后血Na＋、Cl^-、血糖差异无统计学意义（P均〉0．05），K^＋明显降低[换血前为（4．45±2．40）mmol／L，换血后为（3．87±0．52）mmol／L，k21．979，P〈0．05]。换血后总胆红素、Hb、PLT、WBC、血清游离钙下降[换血前总胆红素、Hb、PLT、WBC、血清游离钙分别为（511．52±80．21）μmoL／L、（145．20±11．70）g／L，（207．84±70．67）×10^9／L、（16．90±10．56）×10^9／L、（1．26±0．32）mmol／L，换血后分别为（236．41±66．54）μmol／L、（128．66±2．54）g/L、（134．86±48．61）×10^9／L、（8．94±7．44）×10^9/L、（0．99±0．22）mmol／L，P〈0．05或P〈0．01]。结论换血对高胆红素血症新生儿血Na^＋、Cl^-和血糖无明显影响；对总胆红素、Ca^2＋、Hh、K^＋、PLT、WBC影响较大。

Objective To discuss the influence of blood exchange transfusions on hematomicroenvironment of neonates with hyperbilirubinemian. Methods Blood exchange transfusion was performed in 35 neonates. Mean transfusion volume was （ 136.9 ± 27.4） ml/kg. The speed of blood exchange transfusion was 92 ml/（ kg·h）. Blood bilirubin,blood electrolyte, blood routine and blood sugar levels were measured before, during and after the transfusion. Results Serum total bilirubin （TB） decreased by 53.78% after blood exchange, but there was no change in Na± , Cl^- , and blood sugar （ P 〉 0.05 ） , and K ± was remarkably decreased from （ 4.45 ± 2.40 ） mmoL/L to（ 3.87 ± 0.52 ） mmol/L （ t = 21. 979, P 〈 0.05 ）. TB, Hb, PLT, WBC, Ca2 ± were decreased [ TB from （ 511.52 ± 80.21 ） μmol/L to （ 236.41 ± 66.54 ） μmol/L ; Hb from （ 145.20 ± 11.70 ） g/L to （ 128.66 ± 2.54 ） g/L ; PLT from （207.84 ± 70.67） × 10^9/L to （ 134.86 -±48.61 ） × 10^9/L; WBC from （ 16.90 ± 10.56 ） × 10^9/L to （ 8.94 ± 7. 44） × 10^9/L,and Ca2± from（ 1.26 ±0.32）mmol/L to （0. 99 ±0.22）mmol/L,P 〈0. 05 or 〈0. 01 ]. Conclusions Blood exchange transfusion can not influence Na ^± , Cl^- , and blood sugar, but has remarkable effect on total bilirubin, Ca2± , Hb, K± , PLT, and WBC.