新生儿不同浓度红细胞换血治疗疗效及对内环境的影响  

The efficacy of exchange transfusion with different concentrations of red blood cells and its effect on internal environment in newborns

作　　者：张德双 谢东可 何娜 董文斌 雷小平 ZHANG Deshuang;XIE Dongke;HE Na;DONG Wenbin;LEI Xiaoping(Department of Neonatology,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China)

机构地区：[1]西南医科大学附属医院新生儿科

出　　处：《临床儿科杂志》2019年第12期940-945,共6页Journal of Clinical Pediatrics

摘　　要：目的探讨新生儿换血治疗时不同红细胞和血浆比例对疗效及内环境(血细胞计数、电解质、血糖及酸碱平衡)的影响.方法回顾分析2015年1月至2018年12月经换血治疗的149例高胆红素血症新生儿的临床资料,根据换血时红细胞与血浆的比例分为2:1组(红细胞2 U﹕血浆100 mL,62例)和3:1组(红细胞3 U﹕血浆100 mL,87例).探讨两组换血当时至12小时的血清总胆红素(TSB)下降程度、换血后继续光疗时间及再次换血比例的差异,比较换血前后两组新生儿血常规、电解质、血糖及血气分析的变化.结果两组新生儿的胎龄、出生体质量、性别及换血日龄等差异均无统计学意义(P>0.05);两组在换血结束时及换血后12小时TSB的下降程度,继续光疗时间及再次换血比例的差异均无统计学意义(P>0.05).换血后,3:1组的RBC(3.7±0.4 vs 4.7±0.3)与Hb(118.9±12.1 vs 157.8±14.3)显著上升;同时,换血后两组新生儿的WBC、PLT、血清钠、HCO-3水平降低,而血清钾、血清钙、血糖浓度升高,差异均有统计学意义(P<0.05);但两组间各指标的变化差异均无统计学意义(P>0.05).两组新生儿间常见换血并发症以及急性胆红素脑病和核黄疸的发生率差异无统计学意义(P均>0.05).结论红细胞与血浆以2:1或3:1混合均可有效治疗新生儿高胆红素血症.3:1比例混合血可有效纠正贫血,且未加重换血后机体内环境的紊乱.Objective To investigate the efficacy of different ratios of red blood cells(RBC)to plasma in neonatal exchange transfusion(ET)and the effect on internal environment(blood cell counts,electrolyte,blood glucose and acid-base balance).Methods The clinical data of 149 neonates with hyperbilirubinemia treated with ET from January 2015 to December 2018 were analyzed retrospectively.According to the ratio of RBC to plasma during blood exchange,the patients were divided into the 2:1 group(RBC 2U:plasma 100mL,62 cases)and the 3:1 group(RBC 3U:plasma 100ml,87 cases).The decreases of serum total bilirubin(TSB)at 0-hour and 12-hour after ET,the duration of continuous phototherapy after ET and the percentage of recurrent ET were compared between the two groups.Before and after the ET,the changes in blood cell counts,serum electrolytes,blood glucose and blood gas results were compared between the two groups.Results There were no significant differences between the two groups in gestational age,birth weight,gender and age of ET(all P>0.05).There were no significant differences between the two groups in the decrease of TSB at 0-hour and 12-hour after ET,the duration of continuous phototherapy and the ratio of recurrent ET(all P>0.05).After ET,RBC(3.7±0.4 vs 4.7±0.3)and Hb(118.9±12.1 vs 157.8±14.3)in the 3:1 group were increased significantly.Meanwhile,the white blood cell,platelet,sodium and HCO-3 levels were significantly decreased after ET,while the concentrations of potassium,calcium,and glucose were significantly increased in both groups(all P<0.05)after ET.However,these differences were not significant between the two groups(all P>0.05).Furthermore,the incidence of ET-related complications,acute bilirubin encephalopathy and kernicterus were similar between the two groups(all P>0.05).Conclusions Neonatal hyperbilirubinemia can be effectively treated using mixed RBC and plasma in a ratio of either 2:1 or 3:1.A 3:1 ratio of mixed blood can effectively correct anemia,and does not aggravate the disorder of the internal envi

关 键 词：高胆红素血症 红细胞 血浆 交换输血 新生儿 

分 类 号：R722.1[医药卫生—儿科]