改良式全自动外周动静脉同步换血术在新生儿高胆红素血症中的应用研究  

Study on the application of improved automatic peripheral arteriovenous Synchronization in Neonatal Hyperbilirubinemia

作　　者：陈莲丽 薛峰[1] Chen Lianli;Xue feng(NICU,Shanghai Children's Medical Center,School of medicine,Shanghai Jiaotong University,Shanghai 200127)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心NICU

出　　处：《护士进修杂志》2019年第23期2127-2131,共5页Journal of Nurses Training

摘　　要：目的探讨改良式全自动外周动静脉同步换血术应用于新生儿高胆红素血症的疗效观察与护理。方法选择2017年2月-2018年11月在我科住院治疗并符合换血指征的78例新生儿,将其中2017年2-10月的30例设为对照组,采用传统的换血术;将2017年11月-2018年11月48例设为观察组,采用改良式全自动外周动静脉同步换血术。比较两组患儿换血时间、血常规、BS、Na^+、K^+、Ca^2+、血清胆红素值、生命体征的变化和两组患儿不同动脉位置导管堵塞,导管脱位发生情况及不良反应发生率。结果观察组换血时间为(2.21±0.515)h,明显短于对照组(3.58±2.124)h(P<0.05)。观察组的总胆红素水平较换血前明显降低(P<0.05),且胆红素换出率(59.83%)较对照组(50.38%)高(P<0.05),血小板和白细胞下降不明显(P>0.05),血红蛋白上升(P<0.05)。观察组微量血糖(BS)、钾(K^+)、钠(Na^+)和钙(Ca^2+)与对照组相比较差异均无统计学意义(P>0.05)。观察组在换血中及换血后的生命体征波动不明显,换血中体温、心率和SpO2以及换血后呼吸、心率与对照组比较差异均有统计学意义(P<0.05)。观察组无堵管和移位发生,各项不良反应发生情况与对照组比较,差异均有统计学意义(P<0.05)。结论改良式全自动外周动静脉同步换血术可缩短换血时间,给予患儿有效的镇静和舒适的体位,从而达到疗效可靠和安全有效的应用,临床上可控性强,值得推广。Objective To study and observe the therapeutic effect and nursing of modified fully automatic peripheral arteriovenous synchronous blood exchange applying for neonatal hyperbilirubinemia.Methods 78 cases children patients meet the criteria of blood exchange of neonatal hyperbilirubinemia at Shanghai children medical center from February 2017 to November 2018 was selected.30 cases of them from February to October 2017 were taken as control groups.48 case of them using traditional blood exchange techniques from November 2017 to November 2018 were taken as experimental groups.The clinical effect of the blood exchange was further discussed by using automatic peripheral arteriovenous synchronous blood exchange.The difference of serum bilirubin value,blood routine,internal environment(blood sugar,sodium,potassium and calcium)and vital signs of the two groups of children was evaluated.The application effect of improved automatic peripheral arteriovenous synchronous exchange is further discussed.Results Blood exchange time in the experimental group(2.21±0.515)h was significantly shorter than that in the control group(3.58±2.124)h(P<0.05).The total bilirubin level in the experimental group was significantly lower than that before blood exchange(P<0.05),and the bilirubin exchange rate(59.83%)is higher than that of the control group(50.38%).The platelets and white blood cells in the experimental group did not decrease significantly,and the hemoglobin increased,both of which had statistical significance difference(P<0.05);There was no statistical significance in the experimental group compared with the control group(P>0.05)in trace glucose(BS),potassium(K^+),sodium(Na^+)and calcium(Ca^2+).The vital signs of the experimental group in the blood exchange and after the blood exchange were not obvious,and T,RR,and SpO2 in the blood exchange and HR and RR after the blood exchange were statistically significant difference(P<0.05);The plugging rate(0.00%)and displacement rate(0.00%)in the experimental group were lower than that of

关 键 词：高胆红素血症 新生儿 外周动静脉 同步换轿 护理 

分 类 号：R473.72[医药卫生—护理学]