凝血功能和内环境监测在新生儿高胆红素血症换血治疗过程中的作用

Role of coagulation and internal environmental monitoring in neonatal hyperbilirubinemia exchange transfusion during treatment

目的探讨凝血功能和内环境监测在新生儿高胆红素血症换血治疗过程中的作用。方法收集108例新生儿高胆红素血症换血患儿进行回顾性分析,所有患儿均采用外周动静脉全自动同步换血疗法,将其分为观察组(58例)和对照组(50例),其中对照组采取术中常规监测,而观察组在对照组的基础上采取凝血功能和内环境(血气)监测,且在换血前后从外周同一静脉抽血测定生化指标K^+、Na^+、Cl^-、Ca^(2+)、Mg^(2+)离子;凝血因子:活化的部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)指标;血气氧分压[p(O_2)]、二氧化碳分压[p(CO_2)]、pH指标。比较两组患儿换血前和换血后生化指标、血气指标、凝血因子、免疫状态(CD3^+、CD3^+CD4^+、CD4^+/CD8^+)各项数据变化情况。结果换血后,两组患儿同换血前比较,对照组血清K^+、Na^+、Cl^-、Ca^(2+)、Mg^(2+)离子的变化无明显变化,观察组的K^+、Na^+、Cl^-变化亦不大,但Ca^(2+)、Mg^(2+)离子的变化较大;组间比较,换血后Ca^(2+)、Mg^(2+)离子有显著的变化(P<0.05),而p(O_2)、p(CO_2)比较差异无统计学意义;观察组与对照组换血前后BE的变化较大,且观察组的pH值在换血前后也有大幅变化。观察组换血后较换血前凝血四项异常人数占比均偏低,而对照组仅两项有降低无明显改变;换血后观察组CD3^+、CD3^+CD4^+、CD4^+/CD8^+与治疗前比较均升高(P<0.05);而对照组治疗后CD3^+、CD3^+CD4^+、CD4^+/CD8+均无明显变化。结论外周动静脉全自动同步换血疗法治疗新生儿高胆红素血症对机体血气分析、内环境及凝血常规有一定影响,治疗安全有效,但这些影响不对新生儿构成生命危险。

Objective To investigate the effects of coagulation and internal environment(blood)monitoring on the process of exchange transfusion treatment in neonatal hyperbilirubinemia.MethodsA total of108children who had neonatal hyperbilirubinemia were retrospectively analyzed.All the children were assigned into observation group(58cases)and control group(50cases),and the control group was routinely monitored by intraoperative control,while the observation group was monitored by coagulation function and internal environment(blood gas)on the basis of the approach used in control group.The biochemical indexes including K+,Na+,Cl-,Ca2+,Mg2+,coagulation factors,such as thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),blood oxygen partial pressure[p(O2)],carbon dioxide partial pressure[p(CO2)],pH index,base excess(BE),immune status(CD3+,CD3+CD4+,CD4+/CD8+)were measured before and after transfusion.The changes of biochemical indexes,blood gas index,coagulation factors and immune status(CD3+,CD3+CD4+,CD4+/CD8+)were compared before and after transfusion.ResultsAfter the shake up,serum K+,Na+,Cl-,Ca2+,Mg2+hadno significant changes in control group;while serumK+,Na+,Cl-hadno significant changes,but Ca2+,Mg2+had statistically significantchangesin observation group.By comparison among groups,Ca2+,Mg2+ions hadsignificant changes after the shake up(P<0.05),but p(O2),p(CO2)hadno significant changes.BE had significantchange after the shake up,and the pH value of the observation group wasalso significantly change before and after the shake up,with statistical significance(P<0.05).The number ofcoagulation abnormalitiesdecreased significantlyafter shake up in observation group,while the number of coagulation abnormalitiesdid not change significantly in control group.After exchange transfusion,CD3+,CD3+CD4+,CD4+/CD8+compared with before treatment were significantly increasedin observation group;the differenceswerestatistically significant(P<0.05);yetin the control group CD3+,CD3+CD4+,CD4+/CD8+did not change significantly.ConclusionsPeripheral arteriovenous automatic synchronization blood transfusion therapy of neonatal hyperbilirubinemia is safe and effective.It has certain influence on the body blood gas analysis,internal environment and routine coagulation,which do not constitute dangers to the newborns.