换血治疗对高胆红素血症新生儿血液指标的影响和不良反应观察  

Exchange Transfusion Focusing on Blood Indexes and Adverse Reactions in Neonatal Hyperbilirubinemia

作　　者：唐雀美 王梦雅 陈学军[1] 尹明伟 沈月芳[3] 徐军[1] 金小波[1] TANG Que-mei;WANG Meng-ya;CHEN Xue-jun(Department of Blood Transfusion,The Children's Hospital,Zhejiang University School of Medicine,National Clinical Medical Research Center for Child Health,Hangzhou 310052)

机构地区：[1]浙江大学医学院附属儿童医院输血科、国家儿童健康与疾病临床医学研究中心,杭州310052 [2]浙江中医药大学医学技术学院 [3]浙江大学医学院附属儿童医院药剂科、国家儿童健康与疾病临床医学研究中心

出　　处：《临床输血与检验》2022年第1期33-37,共5页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的探讨换血治疗对新生儿高胆红素血症血液检验指标的影响。方法选取本院2018年1月~2020年9月进行换血治疗的94例新生儿为研究对象,收集并记录新生儿的一般资料、换血前后血液检验指标及出现的不良反应情况。结果94例换血治疗患儿,均是间接胆红素显著升高,其中ABO溶血病28例(29.8%),颅内出血和头皮血肿14例(14.9%),新生儿败血症等感染13例(13.8%),葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏症7例(7.4%),Rh溶血病4例(4.3%),红细胞增多症3例(3.2%),其他综合因素高胆红素血症25例(26.6%)。换血后常规生化指标TBIL、IBIL、DBIL、TP、ALB、ALT、AST、GGT、ALP、CREA、UREA、CysC、LDH、CK、CK-MB水平均较换血前有显著下降(P<0.05);血常规指标WBC、Hct、Hb、Plt较换血前有显著下降(P<0.05);血气、电解质和凝血指标pH、HCO_(3)^(–)、BE、Na^(+)、Cl^(–)、Ca^(2+)水平有显著降低(P<0.05),pO_(2)、K^(+)、Glu、Lac、PT、INR水平较换血前有显著上升(P<0.05);而URIC、pCO_(2)、RBC计数和APTT换血前后差异无统计学意义(P>0.05)。94例患儿换血后,发现低钙血症33例、血小板减少症55例、高血糖83例、代谢性酸中毒41例、高钾血症5例。结论换血疗法是治疗新生儿高胆红素血症的一种有效的方式,可快速清除血清胆红素,但会引起部分血液指标的显著变化和出现一定的换血后不良反应,应在换血过程中密切观察血液检验指标的变化和临床表现,以保障换血安全与疗效。Objective To investigate the effect of exchange transfusion(ET)performed forneonatal hyperbilirubinemia.Methods A total of 94 neonates received ET in our hospital between January 2018 and September 2020 were included.Demographic characteristics,blood indexes before and after ET,and adverse reactions in neonates were recorded.Results Ninety-four neonates underwent ET had significantly increased levels of indirect bilirubin,including 28(29.8%)ABO HDN,14(14.9%)intracranial hemorrhage and cephalohematoma,13(13.8%)neonatal sepsis and other infections,7(7.4%)glucose 6-phosphate dehydrogenase(G-6-PD)deficiency,4(4.3%)Rh hemolysis,3(3.2%)polycythemia,and 25(26.6%)hyperbilirubinemia due to other causes.The levels of total bilirubin and indirect bilirubin,direct bilirubin,total protein and albumin,ALT,AST,GGT and ALP,creatinine,urea,CysC,LDH,CK,CK^(-)MB After ET were significantly decreased than those before ET(P<0.05).WBC count,hematocrit,hemoglobin and platelet count were significantly lower than those before ET(P<0.05).The levels of pH,HCO_(3)^(-),BE,Na^(+)and Cl^(-),and Ca^(2+)were significantly lower than those before ET(P<0.05),but pO_(2),K^(+),glucose,lactic acid,PT,INR after ET were higher than those before ET(P<0.05).No significant differences were found in URIC,pCO2,RBC count and APTT before and after ET(P>0.05).After ET,there were 33 hypocalcemia,55 thrombocytopenia,83 hyperglycemia,41 metabolic acidosis and 5 cases of hyperkalemia.Conclusion ET is an effective treatment for treat neonatal hyperbilirubinemia due to removal of serum bilirubin,but it can cause significant changes in some blood indexes and adverse reactions after ET.The changes of blood indexes and clinical manifestations should be carefully monitored during ET so as to ensure safety and efficacy of ET.

关 键 词：新生儿高胆红素血症 换血 疗效 不良反应 

分 类 号：R457[医药卫生—治疗学]