极危重新生儿应用外周动静脉同步换血疗法的研究

Peripheral arterial and venous synchronous blood exchange transfusion in critically ill full-term newborns

目的探讨运用外周动静脉同步换血疗法治疗极危重足月新生儿的疗效。方法选择2008年7月至2011年12月在我院新生儿重症监护病房住院的足月危重症新生儿,运用同步换血疗法治疗的患儿为观察组,仅采用常规方法治疗的患儿为对照组。监测并比较观察组治疗前后实验室指标,包括血糖、血清Na+、K+、Ca2+、pH、碱剩余(BE)、凝血酶原时间(PT)、活化部分凝血激酶时间(APTT)、血清尿素氮(BUN)、肌酐(Cr)、白细胞介素-1(IL-1)、IL-6、IL-8和肿瘤坏死因子-α(TNF-α)等炎症因子的变化;比较观察组和对照组病死率和好转率。结果观察组9例,对照组11例。观察组治疗后血清Na+、K+、pH、BE、PT、APTT、IL-1、IL-6、BUN和Cr水平均较治疗前好转,差异有统计学意义(P<0.01或0.05);治疗前后血糖、血清Ca2+、IL-8、和TNF-α差异无统计学意义(P>0.05)。观察组死亡6例,病死率66.7%,对照组死亡7例,病死率63.6%,两组差异无统计学意义(P>0.05)。结论运用外周动静脉同步换血治疗极危重新生儿有助于内环境及凝血功能的稳定,并可致部分炎症因子下降。换血疗法可能是极危重症患儿的有效治疗方法之一。

Objective To explore the therapeutic effect of peripheral arterial and venous synchronous exchange transfusion in critically ill full-term newborns. Methods Critically ill full-term newborns hospitalized in neonatal intensive care unit from July 2008 to December 2011 were assigned into two groups. Whereas nine neonates in the observation group were treated with synchronous arterial and venous blood exchange transfusion, 11 neonates in the control group were given conventional treatments and supports without exchange transfusion. Multiple biochemical parameters, including blood glucose, serum Na＋ , K＋ and＇Ca2~ , pH, BE, lYf, APT~, BUN and Cr levels, as well as inflammatory factors： including IL-1, IL-6, IL-8 and TNF-ct levels were compared before and after the exchange transfusion. Meanwhile, the improvement and mortality rate were also compared between the experimental and the control groups. Results While marked imorovements in serum Na~ . K＋ . nil. BE. PT.APTT, IL-1,IL-6, BUN and Cr levels were observed after exchange transfusion （P 〈0. 01or 〈0. 05）, there were no significant differences in blood glucose, serum Ca2＋ , IL-8 and TNF-ct levels before and after exchange transfusions （P 〉0. 05 ）. Mortality rates in the two groups were similar, with 66. 7% in the experimental group and 63.6% in the control group. Conclusions Peripheral arterial and venous synchronous exchange transfusion helps to stabilize the internal environment and coagulation functions in critically ill full-term newborns. Exchange transfusion also leads to decline in the levels of some inflammatory factors; thus, may be used as one of the effective treatments in critically ill newborns.