改良外周动静脉全自动同步换血疗法治疗新生儿重度高胆红素血症的临床研究

A clinical study of the improved treatment of severe neonate hyperbilirubinemia by automatic and synchronous exchange transfusion of peripheral artery and vein

目的探讨改良外周动静脉全自动同步换血疗法治疗新生儿重度高胆红素血症的疗效和安全性。方法选择2016年1月至2019年12月在淮南市妇幼保健院新生儿科换血治疗的新生儿重度高胆红素血症患儿25例为研究对象,换血时建立两条通路,一条动脉通路为放血通路,另一条外周静脉为输血通路(该通路由留置针连接佳士比3000输液泵专用输血皮条,此皮条过滤器上端呈Y型,有两根平行的输血穿刺器,分别插入红细胞血袋和血浆血袋,共用一个过滤器输血。每输入100 mL红细胞,夹闭红细胞血袋端皮条,开放血浆血袋端皮条,再输入50 mL血浆,交替进行),两条动静脉形成换血回路,由3个输液泵控制(第1泵为放血泵,第2泵为输血泵,第3泵为肝素钠输注泵),真正实现了全程全自动换血。观察换血前后血常规、血总胆红素、血气分析、血糖、电解质、血培养及生命体征变化。结果25例患儿中,换血时间90~120 min。换血前后呼吸、心率、血压、电解质、血气分析变化均差异无统计学意义(均P>0.05);换血前后血清总胆红素、血小板均明显下降[换血前后总胆红素(485.8±126.5)μmol/L比(207.9±68.4)μmol/L;换血前后血小板(301.6±118.3)×10^9/L比(125.3±60.2)×10^9/L,t=-6.924、-7.986,均P<0.01];换血后白细胞较换血前下降[换血前(12.57±6.11)×10^9/L,换血后(8.98±3.24)×10^9/L,t=-2.922,P<0.05];换血后微量血糖高于正常值,与换血前差异有统计学意义[换血前(4.9±0.7)mmol/L,换血后(7.1±1.5)mmol/L,t=3.866,P<0.01];换血后24 h内微量血糖恢复正常范围,72 h血小板及白细胞恢复正常。所有病例换血后血液细菌培养均阴性。未发生1例严重并发症,均痊愈出院。结论改良输液泵控制外周动静脉全自动同步换血疗法在治疗重度新生儿高胆红素血症时操作简单、安全,疗效可靠。

Objective To explore the effect and safety of the improved treatment of severe neonate hyperbilirubinemia by the automatic and synchronous exchange transfusion of peripheral artery and vein.Methods From January 2016 to December 2019,25 newborns with severe hyperbilirubinemia treated by automatic and synchronous exchange transfusion of peripheral artery and vein were selected in the research.During the operation of exchange transfusion,there were two pathways,the bloodletting one through the arteries and the transfusion one through the veins[the latter was connected to the blood-conveying leather pipeline special for Graseby 3000 syringe pump by the indwelling needle.The filter of the leather pipeline is Y-shaped and had two parallel blood transfusion plugs,one inserted into the red blood cell(RBC)bag,and the other into plasma bag.After infusion of 100 mL of RBC,clamped the RBC bag,and infused 500 mL of plasma.Then clamped the plasma bag and infused 100 mL of RBC.They were alternately operated].The artery and the vein form a blood circuit,which was controlled by three infusion pumps(the first pump was for bloodletting,the second for transfusion,and the third for heparin sodium infusion).Hence the exchange transfusion became full-automatic.The changes of blood routine,total blood bilirubin(TBIL),blood gas analysis,blood glucose,electrolytes,blood culture and vital signs before and after transfusion were observed.Results A total of 25 patients were studied,and the exchange transfusion time was controlled between 90-120 minutes.After transfusion,there were no statistically significant changes in breathing,heart rate,blood pressure,electrolytes and blood gas analysis(all P>0.05),while the serum TBIL and platelets(PLT)levels were significantly decreased[the amount of TBIL before and after blood transfusion:(485.8±126.5)μmol/L vs.(207.9±68.4)μmol/L;the amount of PLT before and after blood transfusion:(301.6±118.3)×10^9/L vs.(125.3±60.2)×10^9/L](t=-6.924,P<0.01;t=-7.986,P<0.01),and white the blood cells(WBC)was decreased[before blood transfusion:(12.57±6.11)×10^9/L,after blood transfusion:(8.98±3.24)×10^9/L,t=-2.922,P<0.05].The trace blood glucose(TBG)was higher than normal after blood transfusion,with a significant change[before blood transfusion:(4.9±0.7)mmol/L,after blood transfusion:(7.1±1.5)mmol/L,t=3.866,P<0.01].TBG restored within 24 h after exchange transfusion,PLT and WBC backed to normal within 72 h.Blood bacterial culture was negative in all cases after the exchange transfusion.No serious complications occurred and all patients were cured.Conclusion It is simple,safe and reliable to treat severe neonate hyperbilirubinemia by the peripheral automatic exchange transfusion controlled by infusion pumps.The treatment is worthwhile to be recommended for clinical use in primary hospitals.