早产儿贫血临床输血指征的探讨

发布时间：2018-04-12 00:11

本文选题：贫血 + 输血指征　；参考：《吉林大学》2012年硕士论文

【摘要】：早产儿贫血是早产儿的常见并发症之一，分为生理性贫血和病理性贫血，部分早产儿虽有贫血，但无症状，称为早产儿生理性贫血，但当早产儿贫血伴随一定的临床症状时，如皮肤苍白、淡漠、进食困难、体重不增、呼吸困难、心率增快、活动减少，少数病例有下肢、足、阴囊及颜面部水肿，此时早产儿贫血则称为病理性贫血，往往需要干预治疗。早产儿贫血的防治包括减少医源性失血、药物治疗及输血治疗，其中输血治疗是其中最有效、最常见的治疗方法，而目前国内尚无统一的早产儿输血指征，多数都在沿用国外早产儿的输血指征，且国外就早产儿的输血指征尚未达成共识，各新生儿中心与中心之间的标准不同，本研究旨在通过观察我院住院早产儿的输血情况以期为建立我国早产儿合理的输血指征提供一定的临床依据。本文选用2010年10月1日至2011年10月1日之间出生，生后24小时内首次入住我院NICU病房，体重＜1500g，住院时间≥2周且住院期间接受过输血治疗的早产儿96例为研究对象，根据患儿输血前Hct数值分为观察1组54例，观察2组42例。通过对上述患儿的输血情况，包括输血前血红蛋白值、每次输血量、总的输血量、输血次数，以及吸氧、同步间歇指令通气（synchronized intermittent mandatory ventilation, SIMV）、持续正压通气（continuous positive airway pressure, CPAP）时间及人数、呼吸暂停发作人数和发作天数、氨茶碱的使用人数以及使用天数、发生颅内出血、脑白质软化的比例、动脉导管再次开放、早产儿视网膜病（retinopathyof prematurity, ROP）的发生率，真菌感染人数、死亡人数，住院天数等进行记录，并行统计学分析。计量资料符合正态分布的用x±s表示，两组之间的比较采用t检验，不符合正态分布的用M(P25，，P75)表示，两组之间的比较采用秩和检验，计数资料两组之间的比较采用χ2检验。分组后，通过对患儿的基本情况（胎龄、性别、出生体重、入院时基础Hct）行统计学分析比较得出，观察1组和观察2组患儿入院时出生体重、胎龄、性别、入院时HCT差异均无统计学意义，两组具有可比性，进而对观察指标进一步分析得出结论：1.限制性输血可增加极低出生体重儿总的输血量及输血次数。2.非限制性输血可减少极低出生体重儿的呼吸机辅助通气的时间，有利于临床症状的恢复。3.非限制性输血可能减少极低出生体重儿颅内出血的发生，降低真菌感染率及死亡率。
[Abstract]:Anemia in premature infants is one of the common complications of premature infants, which is divided into physiological anemia and pathological anemia. Although some premature infants have anemia, they are asymptomatic, so they are called physiological anemia of preterm infants, but when anemia of preterm infants is accompanied by certain clinical symptoms,If the skin is pale, indifferent, eating difficulty, weight gain, dyspnea, heart rate increase, activity decrease, a few cases have lower limbs, feet, scrotum and facial edema, this time premature anemia is called pathological anemia,Intervention is often required.The prevention and treatment of anemia in premature infants include reducing iatrogenic blood loss, drug therapy and blood transfusion treatment. Among them, blood transfusion therapy is the most effective and most common treatment method. At present, there is no uniform indication of blood transfusion for preterm infants in China.Most of them are following the indications of blood transfusion for premature infants abroad, and there is no consensus on the blood transfusion indications of premature infants abroad. The standards of each neonatal center and center are different.The purpose of this study was to provide a clinical basis for the establishment of reasonable blood transfusion indications for premature infants in China by observing the blood transfusion status of premature infants in our hospital.96 premature infants born between October 1, 2010 and October 1, 2011, who were first admitted to the NICU ward within 24 hours after birth, weighing less than 1500g, staying in hospital for more than 2 weeks and receiving blood transfusion treatment during hospitalization, were selected as the study subjects.According to the Hct values before blood transfusion, 54 cases were divided into observation group (n = 54) and observation group (n = 42).According to the blood transfusion condition of the above children, including the value of hemoglobin before transfusion, the volume of each transfusion, the total amount of blood transfusion, the number of times of blood transfusion, the time and number of oxygen inhalation, synchronized intermittent mandatory ventilation, continuous positive pressure ventilation, continuous positive airway pressure, and the number of CPAPs.The number and duration of apnea, the number and duration of aminophylline use, the incidence of intracranial hemorrhage, the proportion of leukomalacia, the re-opening of ductus arteriosus, the incidence of retinopathy of preterm infants (ROP), the number of fungal infections,The number of deaths and the days of hospitalization were recorded, and the statistical analysis was carried out.The measured data were expressed by x 卤s, the comparison between the two groups was expressed by t test, the comparison between the two groups was expressed by MNP P25 / P75), the comparison between the two groups was expressed by rank sum test, and the comparison between the two groups was analyzed by 蠂 2 test.After grouping, the basic conditions (gestational age, sex, birth weight, basic HCT at admission) were analyzed and compared. The birth weight, gestational age, sex at admission were observed in group 1 and group 2.There was no significant difference in HCT between the two groups at admission, and the two groups were comparable.Restricted blood transfusion can increase the total transfusion volume and blood transfusion times of very low birth weight infants.Non-restrictive blood transfusion can reduce the time of ventilator-assisted ventilation in very low birth weight infants and is beneficial to the recovery of clinical symptoms. 3.Non-restrictive blood transfusion may reduce the incidence of intracranial hemorrhage, fungal infection and mortality in very low birth weight infants.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.6

【引证文献】