新生儿换血不良结局相关因素分析  

Analyse the correlative factors in the adverse events associated with neonatal exchange transfusion

作　　者：赵小朋[1] 宋燕燕[1] 李坚[1] 叶青青[1] 黄翠玲[1] 林斯[1] 

机构地区：[1]广东省广州市妇婴医院新生儿科,510180

出　　处：《中国妇幼保健》2008年第6期797-798,共2页Maternal and Child Health Care of China

摘　　要：目的:探讨新生儿换血所致各种不良结局可能相关的各种危险因素,为临床实施换血提供帮助。方法:不良结局定义为换血7天内发生的任何一种并发症。具体包括:血小板减少症:血小板计数<50×109/L;低钙血症:血清总钙<8mg/dl;代谢性酸中毒:血清重碳酸氢盐<16mmol/L;低血糖:血清糖<40mg/dL;肾衰:血肌酐水平>2.0mg/dl:呼吸停止20s;心搏徐缓:心率<80次/min;血压过低或高血压;呼吸窘迫;抽搐。拟探讨的相关因素包括性别、胎龄、换血时体重、疾病状态、换血日龄及换血成份。结果:换血最常见的不良反应分别是低钙血症、代谢性酸中毒和低钾血症,并多发生于早产儿。胎龄≤32周、换血时疾病状态为导致换血后不良结局发生的独立危险因素(P<0.05),回归系数分别为5.718、8.115,相对危险度分别为6.28(1.77～51.32)、11.73(3.35～41.14)。结论:换血后内环境的改变危险仍然存在,且与胎龄、体重和疾病状态正相关,对于胎龄≤32周合并有各种严重疾病的新生儿,是否实施换血术要慎重对待。Objective： To investigate potential factor attributable to adverse events of neonatal exchange transfusion. Methods： 56 cases records for the past 10 years from neonatal department of my hospital were reviewed retrospectively, adverse events was defined as serious complications occurring within one week of exchange transfusion, include hypokalemia, hyperkalemia, hypocalcemia, hypoglycemia, metabolic acidosis, and thrombocytopenia, tachycardia, hypertension or hypotension, correlative factors include sex, gestational age, weight, healthy or ill. The multiple regression analysis was used to obtain the correlation equations. Results： The common adverse events in the exchange transfusion included hypocalcium, metabolic acidosis, hypokalemia, which was observed commonly in the neonatal infants, gestational ages 〈 32 weeks, heather or ill condition was the independent risk factor, regression index was 5.718, 8. 115 respectively, the relative risk was 6. 28 （ 1.77 -51.32 ） , 11.73 （3.35 -41.14 ） respectively. Conclusion： The accidence of homeostasis change is still existed after exchange transfusion, which is related to gestational ages, and health or ill condition positively, it should be careful to determine whether the exchange transfusion be used, especially for the neonatal infants whose gestational ages ≤32 weeks.

关 键 词：新生儿 换血疗法 分析 

分 类 号：R722[医药卫生—儿科]