Rh阳性血换血治疗Rh溶血病的疗效观察  

Exchange transfusion with Rh positive blood for neonatal Rh hemolytic disease

作　　者：华子瑜[1] 徐天鹤[1] 余加林[1] 漆正常[1] 李世红[1] 陈贻骥[1] 包蕾[1] 王家蓉[1] 沈和平[1] 张先红[1] 袁晓莉[1] 孙辉[1] 

机构地区：[1]重庆医科大学附属儿童医院新生儿科,400014

出　　处：《重庆医学》2003年第4期399-400,共2页Chongqing medicine

摘　　要：目的　比较不同血源用于Rh溶血病换血治疗的效果 ,明确ABO同型Rh阳性血换血治疗对于提高疗效、改善预后是否有明显优势。方法　收集 1987～ 1995年我院新生儿科Rh溶血病换血治疗病例 ,与我院 2 0 0 0年 12月～ 2 0 0 1年 5月Rh溶血病换血治疗的病例 ,将两者的一般情况、换血方法、血源、疗效、预后等进行比较 ,明确ABO同型Rh阳性血换血的优越性。结果　 1987～ 1995年 ,我院新生儿科收治的Rh溶血病 18例 ,换血 11例 ,均采用Rh阴性血 ,经脐静脉换血 (NB组 ) ,换血量 (3 5 4 4 5±12 9 0 6)ml,血清总胆红素 (TB)由 (40 9 3 8± 71 5 9) μmol/L降至 (2 93 18± 116 5 6) μmol/L(P <0 0 5 ) ,下降率 0 2 8± 0 2 9,黄疸退尽时间为 (17 18± 7 0 6)d;2 0 0 0年以后 ,均采用Rh阳性血 ,经外周血管双管同步换血 (PB组 ) ,收治Rh溶血病换血 9例 ,血清总胆红素 (TB)由 (3 5 2 2 7± 14 4 3 8) μmol/L降至 (160 2 8± 5 3 83 ) μmol/L(P <0 0 5 ) ,下降率 (0 5 3± 0 0 8) ,明显高于NB组 (P <0 0 5 )。PB组换血量 (488 89± 12 4 4 4 )ml,较NB组明显增加 (P <0 0 5 ) ;黄疸退尽时间降至 (10 5 6± 1 4 2 )d(P <0 0 5 )。两组换血后血钾均有下降趋势 ,但无统计学差异 (P >0 0 5 )。Objective To confirm whether exchange transfusion(ET) with Rh positive blood is better than the traditional therapy for neonatal Rh hemolytic disease.Methods All cases of Rh hemolytic disease registered in our ward during 1987～2001?some got ET with Rh negative blood other got ET with Rh positive blood.The way of exchange transfusion,blood type,effect and prognosis were compared respectively.Results During 1987～1999,eleven neonates underwent ET of Rh negative through cord vessels(NB group);nine neonates taken ET of Rh positive through peripheral vessels(PB group).In both groups, serum bilirubin(TB) declined significantly after ET( P <0 001).The decreasing rate of TB in PB group was 0.53±0 08,which was greater than that of NB group(0.28±0 29);hospitalization time of PB group were ( 10.56 ±1.42)days, shorter than NB group′s (17.18±7.16)days;blood quantity of PB group was (488.89±124.44)ml,higher than NB group′s (354.45±129.06)ml.All the differences were significant( P <0.05).Conclusion ET with Rh positive through peripheral vessels was more timing and effective for treatment of neonatal Rh hemolytic disease.

关 键 词：新生儿 RH溶血病 Rh阳性血源 换血治疗 

分 类 号：R722.1[医药卫生—儿科]