53例新生儿高胆红素血症换血治疗临床分析  

Clinical analysis of exchange transfusion in 53 cases of neonatal hyperbilirubinemia

作　　者：杨帆 胡三强[1] YANG Fan;HU Sanqiang(Department tof Blood Transfusion,LianyungangMaternal and Child Health Hospital,Lianyungang,Jiangsu,222000,China)

机构地区：[1]连云港市妇幼保健院输血科,江苏连云港222000

出　　处：《临床血液学杂志》2025年第2期126-130,共5页Journal of Clinical Hematology

摘　　要：目的:探讨采用换血疗法治疗新生儿高胆红素血症的效果及不良反应情况,为换血安全及疗效提供指导。方法:收集2018年1月—2023年12月在连云港市妇幼保健院进行换血治疗的53例高胆红素血症新生儿临床资料,根据血型不合及其他不明原因分为:ABO血型不合组(18例)、Rh血型不合组(9例)、不明原因组(26例)3组,分析患儿换血前后总胆红素(TBIL)、血红蛋白(Hb)、血小板计数(PLT)等数据的变化和不良反应情况。结果:ABO血型不合组,全部为O型血孕妇,溶血三项试验(释放试验、游离试验和直接抗人球蛋白试验)结果都为阳性共2例;Rh血型不合组,孕妇均有生产史或流产史,其溶血三项试验结果都为阳性共5例;不明原因组溶血三项试验结果都为阴性。Rh血型不合组直接抗人球蛋白阳性率高于ABO血型不合组(P<0.05)。换血前,不明原因组的TBIL、间接胆红素(IBIL)和Hb均高于ABO血型不合组和Rh血型不合组,差异有统计学意义(P<0.05)。3组中TBIL、IBIL、直接胆红素(DBIL)以及PLT在换血后明显降低(P<0.05),而ABO血型不合组和Rh血型不合组Hb换血前后差异无统计学意义(P>0.05)。换血后,新生儿出现低PLT、低钙血症异常情况上升,差异有统计学意义(P<0.05)。低钾血症16例,代谢性酸中毒5例。结论:换血治疗可以有效降低新生儿高胆红素血症TBIL和IBIL,缓解相应的临床症状,是一种安全有效的治疗措施,但会引起部分血液指标的变化。所以,换血治疗要谨慎细致,在术中以及术后及时监测相关指标的变化,保证临床换血的安全,减少不良反应的发生。Objective:To investigate the effects and adverse reactions of blood exchange therapy in the treatment of neonatal hyperbilirubinemia,and to provide guidance for the safety and efficacy of exchange transfusion.Methods:Clinical data of 53 neonates with hyperbilirubinemia who underwent blood exchange therapy in Lianyungang Maternal and Child Health Hospital from January 2018 to December 2023 were collected.According to blood type incompatibility and other unknown reasons,the children were divided into three groups:ABO blood type incompatibility group(18 cases),Rh blood type incompatibility group(9 cases),unknown reason group(26 cases).The changes of total bilirubin(TBIL),hemoglobin(Hb),platelet(PILT)and other data and adverse reactions before and after exchange transfusion were analyzed.Results:In ABO incompatibility group,all are O type pregnant women.The results of three hemolysis tests(release test,free test and direct anti-human globulin test)were positive in 2 cases.In Rh incompatibility group,all pregnant women had a history of childbirth or abortion.Three tests for hemolysis were positive in 5 cases.All three tests in the unknown reason group were negative.The positive rate of direct anti-human globulin in Rh group was higher than that in ABO group(P<o.O5).Before exchange transfusion,TBIL,indirect bilirubin(IBIL)and Hb of unknown reason group were higher than those of ABO incompatibility group and Rh incompatibility group,and the difference was statistically significant(P<O.05).TBIL,IBIL,direct bilirubin(DBIL)and PLT in the three groups were significantly decreased after blood exchange(P<o.05),but here was no statistical significance in hemoglobin(Hb)in ABO incompatibility group and Rh incompatibility group before and after exchange transfusion(P>0.05).The abnormalities of hypoplatelets and hypocalcemia increased after exchange transfusion,and the differences were statistically significant(P<0.05).There were 16 cases of hypokalemia and 5 cases of metabolic acidosis.Conclusion:Blood exchange therapy can signif

关 键 词：高胆红素血症 换血治疗 新生儿 溶血病 不良反应 

分 类 号：R457.1[医药卫生—治疗学]