外周动静脉同步换血疗法治疗重症高胆红素血症新生儿的疗效分析  

Analysis on the efficacy of simultaneous peripheral arteriovenous exchange transfusion in the treatment of severe neonatal hyperbilirubinemia

作　　者：蒋笑笑 王亚萍 王富明 唐军 Jiang Xiaoxiao;Wang Yaping;Wang Fuming;Tang Jun(Pediatric department,Kaifeng children'shospital,Kaifeng,Henan,475000,China)

机构地区：[1]开封市儿童医院儿科,河南开封475000

出　　处：《齐齐哈尔医学院学报》2022年第17期1682-1686,共5页Journal of Qiqihar Medical University

基　　金：开封市科技发展计划项目(2107011)。

摘　　要：目的探讨经外周动静脉同步换血疗法对重症高胆红素血症新生儿的效果,了解我院新生儿换血疗法的原因、临床效果、可能并发症及护理应对措施、患儿依从性,为临床及护理提供借鉴。方法回顾性分析2018年12月—2021年11月在本院新生儿科实施换血治疗高胆红素血症新生儿的临床资料、实施换血的病因、换血前后血清胆红素情况,相关并发症及实施护理的情况。结果114例重症高胆红素血症新生儿、共119例次新生儿接受了换血治疗,其中57例(50.0%)是ABO溶血病,3例(2.6%)是Rh溶血病,17例(14.9%)是感染性疾病,37例(32.5%)是其他原因引起的重症高胆红素血症;换血治疗前查肝功提示血清总胆红素(TSB)为(424.6±111.2)μmol/L,换血后复查肝功提示TSB为(230.4±60.0)μmol/L,血清总胆红素较换血前有降低(P<0.05)。5.3%(3/57)ABO溶血病患儿进行第2次换血,66.7%(2/3)Rh溶血病患儿进行第2次换血。换血过程中动脉排血不畅12例,血糖偏低8例,低钙血症3例,没有低血糖病例,换血后有血小板减少6例、血红蛋白低5例。没有发生呼吸暂停,没有死亡病例发生。要求出院组患儿血清总胆红素高于缓解出院组患儿,但差异无统计学意义(P>0.05)。结论ABO溶血病及感染性疾病是重症高胆红素血症换血主要原因,换血疗法可有效减轻血清总胆红素;Rh溶血病患儿单次换血效果相对较差,更可能需要2次换血。换血护理过程中及时发现并治疗血糖偏低,适当镇静及安抚,加强穿刺针护理;加强家长对重症高胆红素血症危害的认识,以利于完成治疗及后期随访。Objective Byanalyzing the clinical efficacy of simultaneous peripheral arteriovenous exchange transfusion on children suffered with severe neonatal hyperbilirubinemia,we canmake a research on the causes,clinical effect,possible complications,nursing method,patients’adherence of the exchange transfusion.Then we can provide some reference for clinical and nursing.Methods The medical records(the general data,the reason,the concentration of serum bilirubin,related complications and nursing)of neonatewho received simultaneous peripheral arteriovenous exchange transfusion in pediatric department of our hospital from December 2018 to November 2021 are find out.Results There are 114 patients who received a total of 119 times of exchange transfusion.Fifty-sevenpatients(50.0%)are caused by ABO-hemolytic disease,3 patients(2.6%)by rhesus incompatibility hemolytic disease,17 patients(14.9%)by infectious diseases and 37 patients with severe neonatal hyperbilirubinemia(32.5%)were caused by other diseases.The totalserum bilirubin(TSB)level was(424.6±111.2)μmol/L before simultaneous peripheral arteriovenous exchange transfusion,while the TSB level after exchange transfusion was(230.4±60.0)μmol/L.Total serum bilirubin decreased after exchange transfusion with statistically significant(P<0.05).Three of the 57 children with ABO-hemolytic disease and two of the three children with rhesus incompatibility hemolytic disease received a second exchange transfusion.Arterial obstruction occurred in 12 cases,slight hypoglycemia in 8 cases,hypocalcemia in 3 cases,however,no hypoglycemia occurred during exchange transfusion.Six cases of thrombocytopenia occurred in 6 cases and hypohemoglobinoccurred in 5 cases after exchange transfusion,while there was no apnea and no death.The TSB of the patients discharged from hospital was higher than that of the patients clinical cured with no statistically significant(P>0.05).Conclusions ABO-hemolytic disease and infectious diseases are the main causes of severe neonatal hyperbilirubinemia.Exchange

关 键 词：新生儿 高胆红素血症 外周动静脉同步换血 护理 

分 类 号：R722.1[医药卫生—儿科]