换血治疗新生儿严重高胆红素血症400例

Exchange transfusion treatment for severe hyperbilirubinemia： Analysis of 400 cases

目的 探讨动静脉同步换血疗法在治疗新生儿严重高胆红素血症中的应用疗效及其不良反应.方法 对400例新生儿严重高胆红素血症患儿采用动静脉同步换血疗法,分析换血前后血常规、血气分析、血生化、电解质及不良反应情况. 结果 患儿换血前血清总胆红素、间接胆红素、血红蛋白、血小板、pH值、剩余碱（BE）值和血钾分别为（543.65±129.52） μmol/L、（518.45±122.64） μmol/L、（175.40±33.89） g/L、（295.81±104.96）×109/L、（7.39±0.06）、（-3.78±4.01）、（4.71±0.53） mmol/L,换血后分别为（207.10±60.46）μmol/L、（189.48±60.79） μmol/L、（187.98±22.88） g/L、（120.62±50.64）×109/L、（7.31±0.07）、（-11.27±5.69）、（3.25±0.72） mmol/L,换血前后差异有统计学意义;前三位不良反应有血小板减少、低钾血症、代谢性酸中毒,分别占25.8％、23.8％、17.8％. 结论 动静脉同步换血治疗新生儿严重高胆红素血症疗效显著,但应注意换血后不良反应,严格掌握换血指征及换血适应证,密切监测术后血常规、血生化和电解质的改变等.

Objective To investigate the effect and the adverse events of synchronous exchange transfusion in trea- ting severe hyperbilirubinemia of neonates. Methods A total of 400 newborns with severe hyperbilirubinemia were trea- ted with automated homochronous arteria-vein exchange transfusion. Changes in blood cell counts, bilirubin, biochemistry items and adverse reactions were compared before and after therapy. Results The differences of serum total bilirubin and indirect bilirubin, hemoglobin, platelet and potassium, pH value, and BE value were statistically significant between before and after the exchange transfusion. Adverse reactions were observed for thrombocytopenia （ 25. 8 % ）, hypokalemia （23.8 % ）, metabolic acidosis （ 17.8 % ）, and hyperglycemia （ 11.0 % ）. Conclusion Synchronous exchange trans- fusion has the advantage of obvious curative effect, but close attention needs to be paid to adverse reactions. Indications for the change should be followed; close monitoring of postoperative routine blood and the change of blood biochemical and e- lectrolyte is crucial.