双阶段单倍容量换血术治疗新生儿高胆红素血症临床分析

Clinical Analysis of Two-Stage Single-Volume Exchange Transfusion in Hyperbilirubinemia of Neonate

目的:探讨双阶段单倍容量换血疗法在新生儿重度高胆红素血症中的临床应用价值。方法:对43例重度高胆红素血症新生儿采用外周动静脉同步换血疗法,比较换血前后血清总胆红素(TBIL)、电解质、血气分析、血糖、血红蛋白(Hb)、血小板(PLT)及不良反应发生情况。结果:换血后总胆红素水平下降明显,总胆红素换出率为54.6%(P<0.01);Hb、PLT、hct、K+、Ca2+和p H下降(P<0.01);血糖升高(P<0.01),36 h内恢复正常。不良反应发生率排名前4位分别为为血小板减少(30.2%)、低钾血症(23.2%)、代谢性酸中毒(16.3%)、暂时性高血糖(14.0%)。结论:双阶段单倍循环血量换血术可迅速降低血清胆红素水平,操作简单、安全,是新生儿换血中较理想的方法。注意换血后不良反应的发生情况,严格掌握换血指征,密切监测换血术后血常规、电解质等指标的变化;神经系统预后情况仍需进一步随访。

Objective： To investigate the clinical value of two-stage single-volume exchange transfusion in severe hyperbilirubinemia of neonate. Methods： Forty-three neonates with severe hyperbilirubinemia underwent peripheral arteriovenous synchronous exchange transfusion,and the changes in the serum total bilirubin（ TBLI）,electrolytes,blood gasses,blood glucose,hemoglobin（ Hb）,platelets（ PLT） and the adverse reactions after the exchange transfusion were evaluated. Results： Treatment with the exchange transfusion resulted in a significant reduction in the total serum bilirubin with an exchange rate of 54. 6%（ P 0. 01）. The levels of hemoglobin,platelets,hematocrit（ hct）,serum kalium,ionized calcium and p H showed reductions while blood glucose exhibited a significant elevation change after the transfusion（ P0.01）,But all results returned to normal within 36 hours. Adverse reactions were observed for thrombocytopenia（ 30.2%）,hypokalemia（ 23.2%）,metabolic acidosis（ 16.3%） and temporary hyperglycemia（ 14. 0%）.Conclusion： Two-stage single-volume exchange transfusion can rapidly reduce serum bilirubin levels in neonates with severe hyperbilirubinemia. The operation is not only simple and safe,but close monitoring of postoperative routine blood and the change of blood biochemical and electrolyte is crucial. However long-term prognosis of neural system is still unknown.