动静脉同步换血术治疗新生儿ABO溶血症的应用观察  

Application of synchronous arteriovenous exchange in neonatal ABO hemolysis

作　　者：许穗 傅睿[1] 陈丽萍[1] 卢文青[1] 晏长红[1] 江英[1] 李琳[1] 王巧芳[1] Xu Sui;Fu Rui;Chen Liping;Lu Wenqing;Yan Changhong;Jiang Ying;Li Lin;Wang Qiaofang(NICU,Children's Hospital of Jiangxi Province,Nanchang,Jiangxi 330006,China)

机构地区：[1]江西省儿童医院NICU,南昌330006

出　　处：《中国基层医药》2020年第7期819-823,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:通过比较新生儿ABO溶血症患儿换血前后的血清间接胆红素水平及内环境指标变化,评估换血术的疗效。方法:回顾性分析江西省儿童医院2017年1月至2018年10月达到换血指征的新生儿ABO溶血症患儿242例的临床资料,根据近亲属是否签字同意换血治疗分成两组。换血组126例(常规治疗+换血),对照组116例仅常规治疗(照蓝光+益生菌+丙种球蛋白),换血组分别于患儿换血前半小时(T1)、换血结束后半小时(T2)2个时点,而对照组分别于患儿近亲属签署不同意换血时(T1)、不同意换血并治疗后1 d(T2)2个时点,采外周静脉血,测定血清间接胆红素、血小板、血糖。结果:换血组及对照组2个时点血清间接胆红素均降低,差异有统计学意义[(194.010±41.065)μmol/L比(390.048±39.058)μmol/L、 t=1 507.604,(292.014±39.998)μmol/L比(383.452±42.820)μmol/L、 t=306.820,均 P<0.05],且换血组的血清间接胆红素降低幅度较对照组明显,差异有统计学意义[(194.010±41.065)μmol/L比(292.014±39.998)μmol/L、 t=368.267, P<0.05],换血后血小板、血糖均有明显下降,差异有统计学意义[(91.370±24.766)×10 9/L比(350.660±32.564)×10 9/L、 t=5 061.203,(2.965±0.593)mmol/L比(5.490±0.876)mmol/L、 t=717.817,均 P<0.05];换血组下降的血小板、血糖3 d内能自行恢复正常。 结论:动静脉同步换血术能显著降低新生儿ABO溶血症患儿的胆红素水平,减少胆红素脑病的发生率,对新生儿ABO溶血症患儿的内环境有一定影响,易造成血小板减少,血糖降低。但内环境的变化是暂时的,可逆的。Objective To evaluate the effect and influence of exchange transfusion on neonatal ABO hemolysis by comparing the changes of indirect bilirubin in serum and internal environment before and after exchange transfusion.Methods A retrospective analysis of 242 cases with neonatal ABO hemolytic disease from January 2017 to October 2018 in the Children's Hospital of Jiangxi Province was carried out.According to whether the parents signed or agreed to exchange transfusion,they were divided into two groups.The exchange group(126 cases)received routine treatment+exchange of blood,and the control group(116 cases)was only given conventional therapy(blue light+probiotics+gamma globulin).In the exchange group,peripheral venous blood was collected half an hour before the exchange of blood(T1)and half an hour after the exchange of blood(T2),while in the control group,the indirect bilirubin,platelet and blood sugar were measured at two time points of parents signing disapproval of exchange of blood(T1)and disapproval of exchange of blood and one day after the treatment(T2).Results The indirect bilirubin levels in serum of the exchange group and the control group were decreased,and the difference was statistically significant[(194.010±41.065)μmol/L vs.(390.048±39.058)μmol/L,t=1507.604,(292.014±39.998)μmol/L vs.(383.452±42.820)μmol/L,t=306.820,all P<0.05].The decrease of serum indirect bilirubin in the exchange group was more significant than that in the control group,and the difference was statistically significant.[(194.010±41.065)μmol/L vs.(292.014±39.998)μmol/L,t=368.267,P<0.05].After exchange transfusion,the levels of platelet and blood sugar were decreased significantly,and the differences were statistically significant[(91.370±24.766)×109/L vs.(350.660±32.564)×109/L,t=5061.203,(2.965±0.593)mmol/L vs.(5.490±0.876)mmol/L,t=717.817,all P<0.05].Decreased platelets and blood sugar could return to normal within 3 days.Conclusion Exchange therapy can significantly reduce the level of bilirubin and the incidence of

关 键 词：新生儿 ABO溶血症 高胆红素血症 光疗 换血 疗效 影响 胆红素脑病 

分 类 号：R722[医药卫生—儿科]