外周动静脉同步换血治疗新生儿高胆红素血症

目的探讨外周动静脉同步换血治疗新生儿高胆红素血症疗效。方法对符合换血指征的25例患儿采用外周静脉（大、小隐静脉或手、足背静脉）输血，同步外周动脉（桡动脉或肱动脉）抽血，换血速度10—20ml／5min，换血量为患儿两倍总血量（150—180ml／kg），换血前后监测血清总胆红素、间接胆红素、直接胆红素、血生化及血常规。结果换血后血清三种胆红素浓度均显著下降（P〈0．01），总胆红素换出率为52．6％，间接胆红素换出率为53．2％，直接胆红素换出率为38．0％。血常规中血红蛋白明显升高（P〈0．01），而白细胞、血小板则在正常范围内明显下降（P〈0．01；〈0．05）。血钾、钠、钙换血前后无明显变化（P〉0．05），而血糖明显升高（P〈0．01）。结论外周动静脉同步换血治疗新生儿高胆红素血症疗效显著，操作简单，方便快捷，值得推广应用。

Study on treatment or neonatal byperbilirublnemla by peripheral arterloveaous synchronous simultaneous exchange transfusion treatment

Objective To study the effect of peripheral arteriovenous synchronous simultaneous exchange transfusion on neonatal hyperbilirubinemia. Metheds 25 patients were selected and treated by transfusion to peripheral venous( great or small saphenous vein, vein on back of hand or dorsum of foot), while drawing blood from peripheral artery(radial artery or brachial artery). Synchronous exchange transfusion speed was 10- 20 ml per 5 minutes, and the prepared blood was twice as much as the children's total blood volume ( 150～180 ml/kg). The total serum bilirubin, indirect bilirubin, direct bilirubin, electrolyte and blood routine were detected before and after exchange transfusion. Results The concentration of three kinds of bilirubin reduced significantly(P<0.01 ). The exchange rates of total serum bilirubin, indirect bilirubin, direct bilirubin were 52.6％, 53.2％ and 38.0％ after exchange transfusion,respectively. Hemoglobin was increased( P<0.01 ),while leucocyte (P<0.01) and platelet (P<0.05 ) decreased in normal range. No significant changes were found in blood potassium, sodium and calcium, while serum glucose was increased (P<0.01 )after exchange transfusion. Conclusion Peripheral arteriovenous synchronous simultaneous exchange transfusion treatment for servere neonate hyperbilirubinemia is a simple, effective way Application should be promoted.