重症新生儿溶血症换血治疗中的监测与处理

Monitoring and Management of Blood Replacement for Severe Hemolytic Disease of Newborn

目的 :回顾性分析新生儿溶血症换血治疗中的监测与处理 ,并推荐一种便利安全的换血双通道。方法 :对 5例 6人次重症新生儿溶血症实施换血治疗 ,在静脉复合麻醉下以患儿血容量的 2倍进行同步换血 ,并监测心电图、脉搏血氧饱和度、呼吸频率、肛门温度、中心静脉压。结果 :换血过程中血清电解质、血糖及血肌肝无明显变化 ,而随换血量的增加 ,中心静脉压呈升高趋势 ,体温呈下降趋势。结论 :⑴安定氯胺酮静脉复合麻醉可满足换血治疗的要求 ;⑵经脐静脉插管及外周套管针双通道配合三通装置 ,方便安全 ;⑶换血过程中静脉压的变化具有指导换血速度及换血量的作用。

Objective To make a retrospective analysis of the monitoring and management of blood replacement for hemolytic disease of newborn, and to recommend a convenient and safe two-way replacement.Methods 5 cases (6 times), all receiving intravenous anesthesia, underwent a synchronous double-volume blood replacement, during which monitored were such variables as EKG, SPO 2 (Pulse oxygen saturation), respiratory rate , rectal temperature , and CVP(central venous pressure).Results During the replacing, temperature tends to fall and CPV to rise with the increase in exchanging blood volume. The levels of serum electrolyte and blood sugar maintain stable.Conclusion Valium-ketamine combined intravenous anesthesia can yield satisfactory anesthesia level. The CPV change during the replacement can serve as a guide to the rate and volume of blood replacement.