新生儿溶血病类型及抗体分布与输血疗效的分析与探讨  

Analysis and discussion on the hemolytic disease of newborn requiring blood exchange transfusion

作　　者：张瑜[1] 刘玉芳 许亚莉[1] 万春晶 王宝燕[1] ZHANG Yu;LIU Yufang;XU Yali;WAN Chunjing;WANG Baoyan(Department of Blood Transfusion,the First Affiliated Hospital of Xi'an Jiao Tong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院输血科,陕西西安710061

出　　处：《中国输血杂志》2020年第4期342-345,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨新生儿溶血病(HDN)的类型、抗体分布与输(换)血治疗的血液配型方案及疗效的关系。方法收集本院新生儿科2016年1月—2019年12月共350例住院HDN临床资料,包括年龄、性别、体重、胎次,回顾性统计患儿的溶血类型、血型抗体分布与治疗转归,分析其中输(换)血病例的血液配型方案,并以输血前后患儿血红蛋白(Hb)的变化评估其输血效果,以换血前后患儿的胆红素(Bil)和血红蛋白(Hb)的变化评估其换血效果。结果本组新生儿溶血病例中,ABO-HDN占94%(329/350),换血率为0.91%(3/329);Rh-HDN占5.43%(19/350),换血率为42.1%(8/19);ABO+MNSs-HDN占0.29%(1/350);Rh+Kidd-HDN占0.29%(1/350)。按照推荐方案输(换)血,11名输血患儿的输血次数1—2(1.82±0.40)次、(47.55±6.86)mL/次、输血量40—10(86.4±21.09)mL,输血前后Hb(g/L)分别为85.00±21.66 vs 125.09±12.96(P<0.05);12名换血患儿的换血次数1—2(1.17±0.39)次、(516.59±123.64)mL/次、换血量300—1403(602.69±279.05)mL;换血前后TBil(μmol/L)分别为327.22±97.40 vs 206.26±62.92(P<0.05),IBil(μmol/L)分别为295.66±110.98 vs 187.99±62.61(P<0.05),DBil(μmol/L)分别为37.23±31.83 vs 18.24±12.46(P>0.05);Hb(g/L)分别为105.64±44.94 vs 143.00±22.09(P<0.05)。结论HDN虽然以ABO血型系统最多见,但输(换)血疗法主要应用于Rh HDN,换血后Bil降低、Hb提升效果更明显。Objective To explore the relationship between the efficacy of blood transfusion/exchange transfusions(ETs)in neonates diagnosed as hemolytic disease of newborn(HDN)and related factors such the blood type and antibody distribution.Methods The clinical data of 350 HDN cases in Neonatal Department of our hospital from January 2016 to December 2019 were collected,including age,sex of newborn,birth order,blood type of newborn,antibody titer and outcome of newborn,were retrospectively analyzed.Respective matching protocols for transfusion/ETs was conducted.The efficacy of transfusion was valuated by Hb increased and the efficacy of ETs was valuated by both of increase in Hb and fall in Bil.Results Out of the 350 HDN newborns,329 were of ABO-HDN(94%),among which 3(0.91%)required ETs,19 were of Rh-HDN(5.43%),among which 8(42.1%)required ETs,while ABO+MNSs and Rh+Kidd constituted 1(0.29%)and 1(0.29%)case respectively.According to the transfusion/ETs protocol recommended,11 neonates transfused for 1.82±0.40 times(rang 1—2),with(47.55±6.86)mL per time,and the mean amount(mL)was(86.4±21.09)(rang 40—110).The average Hb increased significantly after transfusion(85.00±21.66 vs 125.09±12.96)(P<0.05).ETs were conducted on 12 neonates for 1.17±0.39 times(rang 1—2),with 516.59±123.64(mL)per time,and the mean amount(mL)602.69±279.05(rang 300—1403).The mean level of TBil(μmol/L),IBil(μmol/L)and DBil(μmol/L)of HDN newborns received ETs was 206.26±62.92,187.99±62.61,and 18.24±12.46,which came down significantly as compared with the respective level prior to ETs(327.22±97.40,295.66±110.98 and 37.23±31.83,respectively)(P<0.05).While the mean level of Hb increased significantly after ETs(105.64±44.94 vs 143.00±22.09)(P<0.05).Conclusion Though the probabilities of HDN were lower in Rh blood system than ABO system,most of the transfusion/ETs were employed in Rh-HDN,which can effectively decrease Bil level and improve Hb level.

关 键 词：新生儿溶血病 RH血型 ABO血型 换血配型方案 输血 

分 类 号：R457.11[医药卫生—治疗学] R722.18[医药卫生—临床医学]