新生儿换血治疗49例分析

Analysis of 49 neonates received exchange transfusion

目的:探讨导致新生儿换血的病因,换血前后患儿胆红素水平及血常规、血生化等内环境指标的变化。方法:对49例北京儿童医院新生儿换血病例,统计分析导致换血病因;换血前后分别检测患儿胆红素、血生化、血气分析及血常规,并进行比较。结果:49例患儿中因母婴血型不合导致换血41例,遗传型球型红细胞增多症3例,红细胞葡萄糖-6-磷酸脱氢酶缺乏症2例,原因不明的高胆红素血症患儿3例。换血治疗前后血清总胆红素和间接胆红素水平下降52%,血小板、白细胞计数显著减少。患儿的血钾、血氨明显下降(P<0.01),血钠和血钙水平换血前后差异无统计学意义(P>0.05),但血糖水平显著升高(P<0.01)。换血治疗前后血气分析指标无明显波动(P>0.05)。结论:母婴血型不合是导致新生儿换血的主要原因。换血治疗新生儿高胆红素血症可以有效降低患儿体内胆红素水平,对患儿血液内环境有一定影响。

Objective：To explore the diseases causing exchange transfusion on neonates,and changes of serum bilirubin,blood cell counts and biochemistry items before and after exchange transfusion of neonates with hyperbilirubinemia.Method：Data of 49 neonates received exchange transfusion in Beijing Cchildren＇s Hospital were analyzed.Serum bilirubin,blood cell counts,biochemistry items and blood gas were monitored and compared before and after exchange transfusion.Result：Of the 49 neonates received exchange transfusion,41 cases were caused by maternal infant blood group incompatibility,3 were hereditary spherocytosis and 2 were glucose-6-phosphate dehydrogenase.The causes of hemolysis in 3 neonates were unknown.After exchange transfusion,the average level of serum bilirubin in 49 neonates decreased by 52%.The average levels of platelet and white blood cell count and serum kalium,ammonia decreased significantly（P0.01）.The level of serum natrium and calcium kept stable.But the serum glucose increased obviously（P0.01）.The blood gas items did not change obviously.Conclusion：The maternal infant blood group incompatibility was the main cause leading to exchange transfusion in neonates.The level of serum bilirubin in neonates with hyperbilirubinemia could be decreased effectively by exchange transfusion,which would have certain effects on the internal environment of neonates.