新生儿红细胞增多症38例临床分析  

Clinical analysis of 38 cases of neonatal polycythemia

作　　者：钟晓冰 朱顺叶[1] 唐本玉[1] 

机构地区：[1]中山大学附属第三医院儿科,广州510630

出　　处：《新医学》2017年第5期351-353,共3页Journal of New Medicine

基　　金：广东省科技计划项目(2014A020212392)

摘　　要：目的总结新生儿红细胞增多症(NP)的临床特点及诊治经验。方法回顾性分析38例NP患儿的临床表现、治疗、转归及随访等临床资料。结果 38例NP中早产儿10例,足月儿27例,过期产儿1例;小于胎龄儿8例,适于胎龄儿27例,大于胎龄儿3例;单胎33例,双胎5例;脐带缠绕4例;出生合并窒息2例,出生时羊水粪染2例;有胎盘输血病史(包括双胎输血、胎儿母体输血、围生期缺氧等)9例,无特殊病史12例;母亲患妊娠期糖尿病6例,母亲患妊娠期高血压疾病2例,母亲患甲状腺功能减退症1例。首发症状包括高胆红素血症(73.7%),发绀、血氧降低或气促(60.5%),多血质外貌(21.1%)等;主要治疗方式包括部分换血29例,其中3例换以等量血浆,6例换以等量白蛋白,20例换以等量生理盐水;静脉输注低分子右旋糖酐16例;同时积极治疗并发症及合并症。除2例自动出院外,其余36例经治疗后血红蛋白及红细胞压积均明显下降,临床症状、体征好转后痊愈出院。17例随访成功的患儿情况均良好。结论 NP与宫内慢性缺氧、胎儿输血等因素有关;部分换血治疗NP效果显著且相对安全;大部分患儿预后良好。Objective To summarize the clinical characteristics and experience in the diagnosis and treatment of the neonatal polycythemia （NP）. Methods Clinical data including clinical manifestations, treat-ment, prognosis and follow-up of 38 NP cases were retrospectively analyzed. Results Among 38 NP cases, 10 were preterm infants, 27 full-term infants and 1 perinatal infant. Eight infants were aged 〈 gestational age, 27 at gestational age and 3 〉 gestational age. Thirty-three cases were single birth and 5 twin pregnancy birth.Four cases had umbilical cord entanglement. Two cases were complicated with asphyxia upon birth delivery.Two presented with meconium-stained amniotic fluid. Nine cases had a medical history of transplacental trans-fusion diseases including twin pregnancy transfusion, fetomaternal transfusion and perinatal hypoxia, etc.Twelve cases had no history of specific diseases. Six mothers were diagnosed with gestational diabetes mellitus,2 with gestational hypertension and 1 with hypothyroidism. Primary symptoms included hyperbilirubinemia （73. 7% ） , cyanosis, reduction in blood oxygen or shortness of breath （60. 5% ） and sanguineous appearance （21. 1 % ） , etc. Twenty-nine cases received partial exchange transfusion including plasma transfusion in 3 , al-bumin transfusion in 6 and physiological saline in 20. Intravenous infusion of low-molecular-weight dextran was administered in 16 cases. Corresponding measures were actively taken to treat relevant complications. Two ca-ses were discharged without treatment. For the remaining 36 cases, hemoglobin level and hematocrit were sig-nificantly decreased, relevant symptoms were obviously improved and physical signs restored to normal after corresponding interventions. Conclusions NP is associated with chronic intrauterine hypoxia, fetal blood transfusion and other factors. Partial exchange transfusion is an efficacious and safe approach for the treatment of NP. A majority of affected infants obtain favorable clinical

关 键 词：新生儿 红细胞增多症 部分换血 

分 类 号：R722.1[医药卫生—儿科]