新生儿高胆红素血症换血疗效观察与分析  

Observation and analysis on therapeutic effect of exchange transfusion on neonatal hyperbilirubinemia

作　　者：邱小兰[1] 钟昌瑞[1] 胡俊琳 李玉闽[1] QIU Xiao-lan(Department of blood transfusion,Longyan first hospital affiliated to Fujian medical university,Longyan,Fujian,364000,China.)

机构地区：[1]福建省医科大学附属龙岩市第一医院输血科,福建龙岩364000

出　　处：《齐齐哈尔医学院学报》2019年第3期325-327,共3页Journal of Qiqihar Medical University

摘　　要：目的观察新生儿换血治疗高胆红素血症的效果,为其早期治疗及其监测提供临床依据。方法分析92例重度高胆红素血症新生儿进行换血治疗前后生化和血液分析等指标变化。结果引起新生儿高胆红素血症的主要病因有:葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏症有48例(52.18%);新生儿感染有28例(30.43%);母婴ABO及Rh血型不合溶血病有11例(11.96%);另有早产儿、低体重儿、脐带出血等其它病因5例(5.43%)。重度高胆红素血症新生儿术后,血清总胆红素、间接胆红素和直接胆红素水平明显低于术前,差异有统计学意义(P<0.05);白细胞数、红细胞数、血红蛋白和血小板数明显低于术前,差异有统计学意义(P<0.05);红细胞压积术前、术后变化不大,差异无统计学意义(P>0.05)。总胆红素换出率为(50.30±10.46)%。术后血小板减少症(<100×10~9/L)发生率为75%,92%的血小板减少症患儿在24～48 h血小板数值可恢复正常水平。结论换血疗法可以快速降低血液中总胆红素水平及体内的有害物质,是一种安全、有效的治疗方法,但要加强血液学和生化指标监测,降低换血治疗的风险。Objective To observe the effect of neonatal blood exchange for hyperbilirubinemia,and provide clinical basis for the early treatment and monitoring of hyperbilirubinemia. Methods The changes of biochemical and hematological parameters were analyzed in 92 neonates with severe hyperbilirubinemia before and after the exchange of blood.Results The main causes of hyperbilirubinemia in neonates were as follows: 48 cases( 52.18%) were lack of glucose-6-phosphate dehydrogenase( G-6-PD).There were 28 cases of neonatal infection( 30.43%).There were 11 cases( 11.96%) of ABO and Rh incompatibility hemolysis in maternal and infant. In addition,there were 5 cases of premature infants,low-weight infants,umbilical cord bleeding and other causes( 5.43%). The levels of total bilirubin,indirect bilirubin and direct bilirubin in neonates with severe hyperbilirubinemia were significantly lower than those before operation,and the difference was statistically significant( P<0.05).The number of white blood cells,red blood cells,hemoglobin and platelets were significantly lower than those before the operation,and the difference was statistically significant( P < 0. 05). There was no significant difference between the hematocrit before and after the operation( P> 0.05). The exchange rate of total bilirubin was( 50.30 ± 10. 46) %. The incidence of postoperative thrombocytopenia( less than 100 × 10~9/L) was75%,and 92% of thrombocytopenia patients returned to normal levels at 24 ~ 48 hours. Conclusions Exchange transfusion could reduce the level of total bilirubin and harmful substances in the body quickly. It is a safe and effective treatment method,but we need to strengthen the monitoring of hematology and biochemical indicators and reduce the risk of exchange transfusion.

关 键 词：换血 高胆红素血症 新生儿 疗效 

分 类 号：R722[医药卫生—儿科]