影响换血疗法治疗新生儿高胆红素血症疗效及不良事件发生的多因素分析  

Multiple Factors Analysis of Efficacy and Adverse Events of Blood Exchange Transfusion in Neonates with Hyperbilirubinemia

作　　者：龙丽华 李禄全[2] 余加林[2] 张先红[2] 袁晓丽[2] 

机构地区：[1]铜仁地区人民医院儿科,贵州铜仁555100 [2]重庆医科大学附属儿童医院新生儿诊治中心,重庆400014

出　　处：《实用儿科临床杂志》2011年第14期1096-1098,共3页Journal of Applied Clinical Pediatrics

基　　金：重庆市重点学科建设经费资助项目(2010-53)

摘　　要：目的探讨影响新生儿高胆红素血症双管同步换血疗法疗效及不良事件发生的因素。方法回顾性分析重庆医科大学附属儿童医院新生儿诊治中心2006年6月-2009年6月收治的160例经外周动静脉双管同步换血治疗的高胆红素血症患儿的临床资料。不良事件定义为发生如下情况之一:换血过程中发生血氧饱和度曾低于85%并持续5 min以上,发生低血压、呼吸暂停或抑制、心率低于100次.min-1并持续5 min以上。分析换血前患儿的疾病状态、内环境指标、换血量及换血速度对不良事件的影响。结果本研究中不良事件发生率为30.63%(49/160例)。换血过程中有不良事件组新生儿的肺动脉高压患病率高于无不良事件组(8.2%vs0,P=0.008),有不良事件组患儿换血前血清钾、钠、氯、钙及镁离子水平、Hb水平与无不良事件组比较差异均无统计学意义(Pa>0.05),2组单位体质量换血量、单位时间单位体质量换血量比较差异也均无统计学意义(Pa>0.05)。胆红素下降数值与单位体质量换血量呈正相关(r=0.330,P=0.000),与换血前胆红素数值呈正相关(r=0.829,P=0.000)。结论影响换血疗法治疗新生儿高胆红素血症胆红素下降幅度的因素为单位体质量换血量及换血前胆红素水平;影响不良事件发生的主要因素为肺动脉高压。Objective To explore the factors associated with efficacy and adverse events of blood exchange transfusion in neonates with hyperbilirubinemia.Methods One hundred and sixty neonates with hyperbilirubinemia were treated by blood exchange transfusion in Children′s Hospital of Chongqing Medical University from Jun.2006 to Jun.2009.The adverse events were defined as one of the following conditions：Low blood oxygen saturation 85% or hypotension or apnea or bradycardia 100 times·min-1,which persisted for more than 5 minutes.The change in electrolytes,bilirubin,white blood cell,platelet,hemoglobin,the concentration of hydrogen carbonate root and pH between before and after exchange transfusion were analyzed retrospectively.The effect of the disease of neonate,internal environment parameters,the exchange transfusion volume and speeding of exchange on the incidence of adverse events were investigated.Results The incidence of adverse events were 30.63%（49/160 cases） during blood exchange transfusion.The prevalence of pulmonary hypertension in neonates with adverse events was higher than those without adverse events（8.2% vs 0,P=0.008）.No significant difference was found between with and without adverse event groups in the levels of K＋,Na＋,Cl-,Ca2＋,Mg2＋and hemoglobin（Pa0.05）.No difference was found concerning the speed of exchange and the exchange transfusion volume between 2 groups also（Pa0.05）.Decreased level of serum bilirubin was positively correlated with the exchange transfusion volume per weight（r=0.330,P=0.000） and the level of bilirubin before therapy（r=0.829,P=0.000）.Conclusions Serum bilirubin level before therapy and the exchange transfusion volume can affect the efficacy of blood exchange therapy for hyperbilirubinemia.The pulmonary hypertension is a risk factor of onset adverse events during blood exchange transfusion.

关 键 词：高胆红素血症 换血疗法 不良事件 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]