输注红细胞对治疗新生儿呼吸窘迫综合征的临床影响  

Clinical effect of red blood cells transfusion on newborns with neonatal respiratory distress syndrome

作　　者：朱柳杰 谢聪[2] 张庆梅 任广立 ZHU Liujie;XIE Cong;ZHANG Qingmei;REN Guangli(Department of Pediatrics,Women and Children's Hospital,School of Medcine,Xiamen University,Xiamen 361001,China;Department of Pediatrics,Guangzhou University of Chinese Medi-cine;Department of Pediatrics,General Hospital of Southern Theatre Command of PLA)

机构地区：[1]厦门大学附属妇女儿童医院儿内科,福建厦门361001 [2]广州中医药大学儿科 [3]南部战区总医院儿科

出　　处：《中国输血杂志》2021年第3期259-262,共4页Chinese Journal of Blood Transfusion

基　　金：广州市科技计划项目(201607010123)。

摘　　要：目的分析新生儿呼吸窘迫综合征(Neonatal respiratory distressyndrome, NRDS)患儿输注红细胞次数相关危险因素,并探讨输注红细胞次数增加的相关并发症及预测指标。方法选择2017年1月~2019年1月住院的NRDS新生儿,根据输注红细胞次数分为输血0次、输血1~2次、输血≥3次,比较3组患儿的临床资料、并发症,分析导致输血次数增加的危险因素。结果 3组新生儿母亲年龄≥35岁率、胎龄、出生体重、入院时血红蛋白量、无创通气时间、新生儿重症监护室(NICU)住院时间、达全肠道喂养时间对输血次数影响的差异均有统计学意义(χ^(2)=14.24,F=28.44,41.70,60.05,3.83,5.97,4.40,均P<0.05);输血≥3次组喂养不耐受、坏死性小肠结肠炎(NEC)、败血症发病率明显高于输血1~2次组、输血0次组,差异均有统计学意义(χ^(2)=19.30,18.68,6.98,均P<0.05)。多因素Logistic回归分析显示患儿出生体重、入院时血红蛋白量、NICU住院时间、达全肠道喂养时间是输血≥3次的独立危险因素(OR=-3.942,-0.186,0.530,0.324,均P<0.05)。受试者工作特征曲线(ROC曲线)显示出生体重、入院时血红蛋白量对输血≥3次的预测效果较好,其ROC曲线下面积分别为0.846、0.802,两者截断值分别为2.315 kg、157.5 g.L^(-1)。结论喂养不耐受、NEC、败血症是NRDS患儿输血次数增加的并发症,而出生体重、入院时血红蛋白量对输血≥3次有较好的预测价值。Objective To analyze the risk factors related to the number of RBCs transfusion in neonates with neonatal respiratory distress syndrome(NRDS), and to explore the complications and the predictive indicators related to the increase of RBCs transfusion frequency. Methods NRDS newborns admitted to our hospital from January 2017 to January 2019 were selected and divided into three groups according to the number of RBCs transfusion, namely, non-transfusion group, 1~ 2 times group, and ≥3 times group. The clinical data and complications of the three groups were compared, and the risk factors leading to the increase of the number of blood transfusion were analyzed. Results Such factors as maternal age ≥35 years old, gestational age, birth weight, hemoglobin(Hb) at admission, non-invasive ventilation time, hospitalization time in neonatal intensive care unit(NICU), total enteral feeding time affected the blood transfusion frequency of the three groups(χ^(2)=14.24,F=28.44,41.70,60.05,3.83,5.97,4.40,P<0.05).The incidence of necrotizing enterocolitis(NEC), septicemia and feeding intolerance in blood transfusion ≥3 times group was significantly higher than that in 1~2 times group and non-transfusion group(χ^(2)=19.30,18.68,6.98,P<0.05). Multivariate logistic regression analysis showed that birth weight, Hb at admission, length of stay in NICU and time of reaching total enteral feeding were independent risk factors for≥ 3 times of blood transfusion(OR=-3.942,-0.186,0.530,0.324,P<0.05).The ROC curve showed that birth weight and Hb at admission were effective in predicting blood transfusion ≥3 times, and the area under the ROC curve were 0.846 and 0.802, respectively, and the truncation values were 2.315 kg and 157.5 g/L. Conclusion Feeding intolerance, NEC and septicemia are the complications of the increased transfusion frequency in children with NRDS, and birth weight and hemoglobin at admission are effective in predicting blood transfusion ≥ 3 times.

关 键 词：新生儿呼吸窘迫综合征 输注红细胞 坏死性小肠结肠炎 预测价值 

分 类 号：R725.6[医药卫生—儿科] R457.1[医药卫生—临床医学]