新生儿RhD溶血病换血术后合并毛细血管渗漏综合征的诊治分析——附2例报告  

Diagnosis and treatment of capillary leak syndrome in RhD-HDN neonates undergoing blood exchange, two cases report

作　　者：张葳 周熙惠 张文君 林晓洁 李小权 王宝燕 ZHANG Wei;ZHOU Xihui;ZHANG Wenjun;LIN Xiaojie;LI Xiaoquan;WANG Baoyan(Department of Neonate,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Blood Transfusion,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院新生儿科 [2]西安交通大学第一附属医院输血科

出　　处：《中国输血杂志》2020年第1期30-34,共5页Chinese Journal of Blood Transfusion

摘　　要：目的探讨及早诊治新生儿RhD溶血病(RhD-HDN)换血术后合并毛细血管渗漏综合征(CLS)的意义。方法收集2名疑似RhD-HDN换血术后合并毛细血管渗漏综合征男性患儿(患儿1、2)的病历资料,检测母亲及患儿的ABO、Rh(D)血型及HDN相关试验,比较患儿换血的详细过程、换血前后的血红蛋白(Hb)、总胆红素(TBIL)值,换血后白蛋白(ALB)及活化部分凝血活酶时间(APTT)、体重变化值。评估RhD-HDN及CLS的诊断及治疗方法。结果患儿1、2母亲血型均为A Rh(-),患儿血型均为A RhD(+),均诊断为RhD-HDN,患儿1、2分别于出生后4 h及产时出现黄疸,遂均做换血治疗。患儿1:换血2次,第1次换血157 mL/kg,A型RhD(-)悬浮红细胞470 mL,同型血浆240 mL,换血时间3.5 h,第2次换血换血种类同第1次,悬浮红细胞462 ml,血浆231 ml,换血时间3 h 20 min。两次换血前后Hb(g/L)为113 vs 146(第1次)、106 vs 146(第2次),TBIL(μmol/L)为331.1 vs 245.1(第1次)、351.5 vs 258.7(第2次);患儿2换血1次,输入A型RhD(-)悬浮红细胞340 mL,AB型RhD(-)血浆180 mL,换血时间3 h。换血前后Hb(g/L)为77 vs 156,TBIL(μmol/L)为219.8 vs 175.1。2名患儿均在换血后出现CLS症状,患儿1诊断为RhD-HDN,新生儿贫血,CLS;患儿2诊断为RhD-HDN,新生儿贫血,类白血病反应,胎粪吸入综合征(MAS)及CLS;经针对原发病、限液、抗感染、利尿、小剂量糖皮质激素、抗微血栓等综合治疗后2名患儿痊愈出院。结论注重孕(妇)期特殊血型的检测、对是特殊血型且发生过抗原暴露的孕妇的抗体效价做动态监测和必要治疗,有助于其娩出的新生儿RhD-HDN的及时诊和预后,减少新生儿换血后发生CLS。Objective To analyze and study the early diagnosis and treatment of capillary leak syndrome(CLS) in two neonates undergoing exchange transfusion(ET) for Rh hemolytic disease(RhD-HDN). Methods Medical records of two male neonates(hereinafter referred to as case 1 and case 2), who were diagnosed as RhD-HDN and had signs suggestive of CLS following ET, were collected. ABO and Rh blood group typing, and HDN-related tests were conducted on samples obtained from the respective maternal and neonate blood. Exchange procedures, post-ET ALB/APTT, as well as Hb, TBIL and weight before/after ET in both neonates were compared. The therapeutic effect of RhD-HDN and CLS were also evaluated. Results The two neonates were diagnosed as Rh HDN as they were A RhD(+) and their mother were A RhD(-). Both of them required ET as neonatal iaundice developed 4 hours after birth in case 1 and at birth in case 2. For case 1, ET was conducted twice, and the volume of blood used for 2 successive ETs was calculated as 157 and 154 mL/kg, respectively;A Rh negative cells(470 mL) suspended in A plasma(240 mL) were given for the first time(with a duration of ET at 3.5 hours), and A Rh negative cells(462 mL) suspended in A plasma(231 mL) for the second time(with a duration of ET at 3 hours and 20 minutes).There was a post-ET increase in Hb(13 vs.146 g/L and 106 vs 146 g/L in 2 successive ETs) and fall in TBIL(331.1 vs 245.1 μmol/L and 351.5 vs 258.7 μmol/L)after 2 times of ET..Case 2 received ET only once, and the volume of blood used for ET was calculated as 192 mL/kg;A Rh negative cells(340 mL) suspended in AB Rh negative plasma(180 mL) were given and the duration of ET was 3 hours. There was a post-ET increase in Hb(77 vs. 156 g/L) and fall in TBIL(219.8 vs. 175.1 μmol/L).Both neonates had clinical signs of CLS following ET. Case 1 was diagnosed as RhD-HDN,neonatal anemia, and CLS;case 2 was diagnosed as RhD-HDN,neonatal anemia,leukemoid reaction,MAS,and CLS. After the comprehensive treatment of primary disease, fluid restriction, anti-infect

关 键 词：RHD血型 新生儿溶血病 换血治疗 毛细血管渗漏综合征 血型检测 

分 类 号：R457.1[医药卫生—治疗学] R722.18[医药卫生—临床医学]