不同比例成分血对新生儿母子ABO血型不合溶血病换血治疗后内环境影响研究  

Effect of different proportions of mixed blood exchange transfusion on blood circulation in neonates with ABO incompatibility hemolytic disease

作　　者：李军[1] 黄瑞文[1] 胡月圆[1] 肖艾青[1] 廖镇宇[1] 

机构地区：[1]湖南省儿童医院新生儿科,长沙410007

出　　处：《中国实用儿科杂志》2011年第9期689-691,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨不同比例成分血对新生儿母子ABO血型不合溶血病(HDN)换血治疗后内环境的影响。方法对2009年1月至2010年4月湖南省儿童医院40例HDN达到换血指征的患儿,采用不同比例成分血行换血术,血源均采用O型浓缩红细胞及AB型血浆。治疗组16例,换血时采用O型浓缩红细胞及AB型血浆的比例为3:1(即O型浓缩红细胞300mL:AB型血浆100mL);对照组24例,采用的比例为2:1。两组换血量均按150～180mL/kg双倍量换血,换血结束后对照组常规输注O型浓缩红细胞15～20mL/kg(总量约60mL),治疗组则不再输血,换血前后其他治疗相同。监测换血前后血清总胆红素、胆红素置换率、血红蛋白、红细胞压积、血清电解质、血气等指标变化。结果两组换血后血清总胆红素均较换血前明显下降,但治疗组下降较对照组更明显,差异有统计学意义(P<0.05)。两组换血前后血红蛋白、红细胞压积比较显示,治疗组换血前后比较差异无统计学意义(P>0.05),对照组比较则差异有统计学意义(P<0.05)。换血后两组血气指标pH、BE值及电解质如K+、Na+、Ca2+、Cl-较换血前差异无统计学意义(P>0.05)。结论采用O型浓缩红细胞及AB型血浆3:1配比的成分血换血治疗HDN,既能迅速降低血清胆红素水平,又能避免贫血的发生,且血清电解质及酸碱平衡在换血前后均无明显差异,值得推广。Objective To explore the effect of different proportions （the 0 type RBCs vs the AB type plasma）of mixedblood exchange transfusion on blood circulation in neonates with ABO incompatibility hemolytic disease. Methods From Jan. 2009 to Apr. 2010 in Hunan Children＇ s Hospital, forty newborn infants with the disease, treated by exchange transfusion with different proportions of mixed blood （AB type plasma was mixed with O type red blood cell）, were randomly divided into two groups： 16 patients in treatment group, who Used O type red blood cells and AB type plasma with the proportion of 3 ： 1 （ the O type RBCs 300 mL： the AB type plasma 100 mL） during blood transfusion; 24 patients in control group with the proportion of 2 ： 1. Both of the two groups received the double exchange transfusion in accordance with 150 - 180 mL/kg. After exchange, all the patients in controll group received O type RBCs transfusion with 15 -20 mL/kg （total volume was 60mL）, while the other group did not. The other therapies in both of the two groups were the same.The indicators, which included the exchange rate of neonatal serum bilirubin, RBC, hemoglobin （Hb）, hematocrit （Hct） , the elctrocyte and gas analysis, were monitored before and after the exchange transfusion. Results The total bilirubin of the two groups were lower after the exchange transfusion, and that the treatment group was even lower（P 〈 0.05）. Before and after exchange transfusion, hemoglobin and hematocrit comparison showed that no significant difference in the treatment group （P 〉 0.05）, while in the control group the difference was significant （P 〈 0.05）. Electrolyte（such as K^＋, Na^＋, Ca^ ＋, C1^＋）and blood gas value before and after the exchange transfusion were not significantly different （P 〉 0.05）. Conclusion The exchange transfusion, using O type red blood cells and AB type plasma with the proportion of 3 ： 1 in hemolytic disease, can not only decrease the level of bilirubin in blood rapidly but

关 键 词：新生儿溶血病 换血疗法 成分换血 

分 类 号：R72[医药卫生—儿科]