| 新生儿黄疸换血疗法对新生儿内环境的影响 |
| |
| 引用本文： | 新生儿黄疸换血疗法对新生儿内环境的影响. 新生儿黄疸换血疗法对新生儿内环境的影响[J]. 首都医科大学学报, 2016, 37(2): 136-140. DOI: 10.3969/j.issn.1006-7795.2016.02.006 |
| |
| 作者姓名： | 新生儿黄疸换血疗法对新生儿内环境的影响 |
| |
| 作者单位： | 首都医科大学附属北京儿童医院新生儿中心, 北京 100045 |
| |
| 基金项目： | 北京市医院管理局临床医学发展专项经费资助(ZY201404) |
| |
| 摘 要： | 目的 回顾性分析首都医科大学附属北京儿童医院新生儿黄疸患儿行换血前后血常规和血液生物化学等指标的变化,为提高临床换血的安全性提供借鉴与帮助。方法 选取1996至2013年于首都医科大学附属北京儿童医院新生儿病房住院并进行换血治疗且临床资料完整的新生儿病理性黄疸病例作为研究对象,收集一般资料换血前后血常规及血液生物化学结果。对换血前后指标进行比较。结果 自1996至2013年,首都医科大学附属北京儿童医院新生儿病房共收治换血患者111例,对85例资料完整的换血病例进行资料分析,在85例换血患儿中,新生儿母子血型不合溶血病81例(95.3%),其中Rh系统血型不合溶血病71例(87.7%),ABO系统血型不合溶血病9例(11.1%),Rh合并ABO系统血型不合溶血病1例(1.2%);葡萄糖-6-磷酸脱氢酶缺乏症(glucose-6-phosphate dehydrogenase deficiency,G6PD)共1例,占1.2%;不明原因的高胆红素血症共3例,占3.5%。经换血治疗后,总胆红素换出率为48.0%,间接胆红素换出率为47.8%。换血后血总胆红素、间接胆红素、直接胆红素、总胆红素与白蛋白比值(bilirubin/albumin,B/A)较换血前明显下降,差异有统计学意义(P<0.05)。红细胞计数、血红蛋白明显升高,差异有统计学意义(P<0.05)。对患儿换血前后小时胆红素进行分析,换血前小时胆红素均位于高危区域内。换血后,低危区33例(38.8%),低中危区22例(25.9%),高中危区16例(18.8%),仍位于高危区域14例(16.5%)。本研究中,换血后发生不良反应的患儿共77例,占90.6%。最常见的不良反应为高血糖症61例(79.2%)、低钙血症46例(59.7%)及低钾血症33例(42.9%),血小板减少症28例(36.4%)及代谢性酸中毒15例(19.5%)发生率也较高。结论 换血疗法对治疗新生儿黄疸治疗效果肯定,能有效地换出血中大量胆红素,降低胆红素脑病的发生风险。同时,因为换血疗法对血液内环境的变化有影响,换血后不良反应发生率相对较高,应严格控制换血指征,换血后需严密监测各项指标。
|
| 关 键 词： | 黄疸 换血疗法 内环境 影响 新生儿 |
| 收稿时间： | 2016-03-01 |
Effect of exchange transfusion on internal environment in neonatal jaundice |
| |
| Wang Xiaojiao,Wang Yajuan,Shao Fang,Yang Xuefang,He Jianping,Wang Huixin,Gu Song,Yang Caiyun,Zhong Yan,Lin Ying,Liu Ying. Effect of exchange transfusion on internal environment in neonatal jaundice[J]. Journal of Capital Medical University, 2016, 37(2): 136-140. DOI: 10.3969/j.issn.1006-7795.2016.02.006 |
| |
| Authors: | Wang Xiaojiao Wang Yajuan Shao Fang Yang Xuefang He Jianping Wang Huixin Gu Song Yang Caiyun Zhong Yan Lin Ying Liu Ying |
| |
| Affiliation: | Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China |
| |
| Abstract: | Objective To summarize the changes of relevant parameters before and after exchange transfusion, and to provide basis for clinical application.Methods Newborns with complete clinical data who underwent exchange transfusion therapy because of jaundice, hospitalized in neonatal ward from 1996 to 2013, were enrolled as the research subjects. A retrospective analysis of clinical data was performed using paired t-test and χ2 test. Results From 1996 to 2013, 111 cases were treated with exchange transfusion in the neonatal ward, data of 85 cases treated with exchange transfusion were collected and analyzed. In this 85 cases treated with exchange transfusion, 81 cases (95.3%) had hemolytic disease, including 71 cases (87.7%) of Rh incompatibility, 9 cases (11.1%) of ABO incompatibility, one case (1.2%) of Rh and ABO hemolytic disease; one case (1.2%) had glucose-6-phosphate dehydrogenase (G6PD) deficiency and 3 cases (3.5%) had unknown hyperbilirubinemia. Exchange transfusion removed 48.0% of total body bilirubin, 47.8% of unconjugated bilirubin. After exchange transfusion, the total serum bilirubin, indirect bilirubin, direct bilirubin and albumin ratio (B/A) was decreased as compared with those of pre-exchange levels, the difference was statistically significant. The red blood cell counts and hemoglobin increased, the difference was statistically significant. Analysis of the one-hour-bilirubin, all of the hour-bilirubin was located in P95 region (100%) before exchange transfusion, which is high risk of bilirubin encephalopathy. After the exchange transfusion, 33 cases (38.8%) located in low risk area, 22 cases (25.9%) in low intermediate risk, 16 cases (18.8%) in high intermediate risk area, and 14 cases (16.5%) still located in P95 region. It suggested that the exchange transfusion can effectively decrease the risk of bilirubin encephalopathy. In this study, 77 cases (90.6%) developed adverse events after exchange transfusion. Among them, the most common adverse event was hyperglycemia in 61 cases (79.2%), hypocalcemia in 46 cases (59.7%), hypokalemia in 33 cases (42.9%), thrombocytopenia in 28 cases (36.4%), and metabolic acidosis in 15 cases (19.5%). Conclusion Exchange transfusion show definite effect in treatment of neonatal jaundice. It can reduce the risk of bilirubin encephalopathy and hemolytic reaction at the same time, and can correct anemia. Exchange transfusion changes the environment of blood. After the exchange transfusion, there is a high incidence of adverse reactions, the indications should be strictly controlled and the parameters should be carefully monitored. |
| |
| Keywords: | jaundice exchange transfusion internal environment influence newborn |
|
| 点击此处可从《首都医科大学学报》浏览原始摘要信息 |
|
点击此处可从《首都医科大学学报》下载免费的PDF全文 |
|
