血浆置换治疗新生儿极重度高胆红素血症疗效分析

The effect of neonatal with very severely hyperbilirubinemia treated by plasma exchange

目的:探讨血浆置换治疗新生儿极重度高胆红素血症的有效性及安全性。方法:回顾性分析2019年4月至12月我院NICU行血浆置换治疗的极重度新生儿高胆红素血症患儿的临床资料,比较血浆置换前后患儿血清总胆红素、间接胆红素、白蛋白、白细胞、红细胞、血小板、红细胞压积、血红蛋白、血钠、血钾、血钙、血糖、凝血及治疗过程中平均动脉压的变化。结果:共纳入符合条件的18例患儿,患儿治疗前总胆红素峰值为(571.2±113.3)μmol/L,治疗后总胆红素为(235.8±66.7)μmol/L,差异有统计学意义(P<0.05),胆红素换出率为(58.5±8.4)%;血浆置换前后患儿的白细胞、血小板、血红蛋白、红细胞压积、血钠、血钾、血氯、血钙、血糖、白蛋白,差异均无统计学意义(P均>0.05);患儿血浆置换过程中无过敏反应、低血压、血浆分离器或管路凝血等不良反应。结论:血浆置换能快速、有效、安全地清除血清胆红素,可能成为新生儿极重度高胆红素血症新的治疗方法。

Objective To explore the effectiveness and safety of plasma exchange in the treatment of neonatal extremely severe hyperbilirubinemia.Methods A retrospective analysis was performed on the data of 18 cases,who were all newborns with extremely severe hyperbilirubinemia and treated with plasma exchange in the NICU at Xi′an Children′s Hospital from April 2019 to December 2019.The changes of serum total bilirubin,indirect bilirubin,albumin,white blood cells,red blood cells,platelets,hematocrit,hemoglobin,serum sodium,serum potassium,serum calcium,blood glucose,blood coagulation and mean arterial pressure were compared before and after plasma exchange.Results A total of 18 eligible children were included.The peak value of total bilirubin was(571.2±113.3)μmol/L before treatment,and the value after treatment was(235.8±66.7)μmol/L,whose difference was statistically significant(P<0.05).The exchange rate of bilirubin was(58.5±8.4)%.There were no statistically significant differences in the changes of white blood cells,platelets,hemoglobin,hematocrit,serum sodium,serum potassium,serum chloride,serum calcium,serum glucose,and albumin before and after plasma exchange(all P>0.05).There were no allergic reactions,hypotension,plasma separator or pipeline coagulation and other adverse reactions during plasma exchange.Conclusion Plasma exchange therapy can remove serum bilirubin quickly,effectively and safely,and may be a new treatment for neonatal hyperbilirubinemia.