单双倍血量换血治疗新生儿高胆红素血症的效果研究

发布时间：2018-11-18 07:51

【摘要】：目的比较单、双倍血量换血在新生儿高胆红素血症中的治疗效果,明确单倍血量换血在减少内环境波动、降低换血相关并发症中是否具有明显优势。方法回顾性分析该院新生儿诊治中心2013年12月至2014年12月行换血治疗的86例高胆红素血症患儿临床资料,以单位体质量换血量将其分为单倍换血量组(80~110 mL/kg,35例)及双倍换血量组(150~180mL/kg,51例),比较两组换血前、后内环境的变化情况及不良事件的发生率。结果 (1)单倍换血量组与双倍换血量组的换血量分别为(98.16±10.75)、(157.78±7.37)mL/kg,胆红素换出率分别为(41.68±8.52)%、(50.22±13.14)%,换血时间分别为(85.60±18.66)、(118.22±24.81)min,两组胆红素换出率与换血时间比较,差异均有统计学意义(P0.05)。(2)两组患儿换血后白细胞(WBC)、血小板(PLT)计数、血清总胆红素(TBIL)、清蛋白、血钾、血钠、血氯、血钙、碳酸氢盐(HCO3-)水平及pH值均低于换血前,红细胞(RBC)计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及血糖水平均高于换血前,差异均有统计学意义(P0.01),其中双倍换血量组换血后血糖、PLT、TBIL变化较单倍换血量组更大,差异有统计学意义(P0.05)。两组患儿换血相关不良事件发生率比较,差异无统计学意义(P0.05)。结论与双倍量换血相比,单倍量换血对内环境影响较小,用血量及人力消耗较少,能明显降低血清胆红素水平,具有较好的临床应用价值。
[Abstract]:Objective to compare the therapeutic effect of single and double blood volume exchange in neonatal hyperbilirubinemia and to determine whether it has obvious advantages in reducing the fluctuation of internal environment and reducing the complications associated with blood exchange. Methods the clinical data of 86 cases of hyperbilirubinemia treated in neonatal diagnosis and treatment center from December 2013 to December 2014 were retrospectively analyzed. The patients were divided into two groups according to the volume of blood exchange per unit body mass (80 ~ 110 mL/kg,). The changes of internal environment and the incidence of adverse events were compared between the two groups before and after blood exchange (n = 35) and double blood exchange (n = 51, 150 ~ 180 mL / kg). Results (1) the exchange rate of bilirubin in haplotype group and double volume group were (98.16 卤10.75), (卤7.37) mL/kg, bilirubin and (41.68 卤8.52)%, (50.22 卤13.14)%, respectively. The exchange time of bilirubin was (85.60 卤18.66), (118.22 卤24.81) min, and the difference was statistically significant (P0.05). (2). Platelet (PLT) count, serum total bilirubin (TBIL), albumin, serum potassium, blood sodium, blood chlorine, blood calcium, bicarbonate (HCO3-) level and pH value were lower than those before blood exchange, erythrocyte (RBC) count, prothrombin time (PT), The activated partial thromboplastin time (APTT) and blood glucose levels were significantly higher than those before blood exchange (P0.01). The changes of blood glucose and PLT,TBIL in the double blood exchange group were greater than those in the single blood exchange group. The difference was statistically significant (P0.05). There was no significant difference in the incidence of related adverse events between the two groups (P0.05). Conclusion compared with double blood exchange, haplohemia exchange has less effect on internal environment, less blood volume and manpower consumption, and can obviously reduce the level of serum bilirubin, which has better clinical application value.
【作者单位】：重庆医科大学附属儿童医院新生儿诊治中心二病房;
【基金】：国家临床重点专科建设项目(国卫办医涵[2013]544号) 重庆市卫计委医学科研项目(20142041)
【分类号】：R722.17

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