外周动静脉同步换血换血量与胆红素水平的关系再研究

目的 　再探讨高胆红素血症外周动静脉同步换血换血量和胆红素下降的关系及修正其公式。方法 　对 1 9例高胆红素血症患儿采用外周动静脉同步换血 ,换血前及每换血 2 5ml/kg时行胆红素系列检测。结果 　高胆红素血症患儿每换血 2 5ml/kg前后血清总胆红素 (TSB)间接胆红素对比均有显著降低 ,每换血 2 5ml/kg的换出率在 6～ 1 1 %之间 ,前后对比无显著意义 ,累积换出 50ml/kg、75ml/kg、1 0 0ml/kg、1 2 5ml/kg和 1 50ml/kg的TSB换出率分别是 1 7 2 1 %± 8 52 %、2 6 1 3%± 1 0 1 1 %、30 0 2 %± 1 0 6 7%、36 82 %± 1 3 1 7%、4 3 6 5%± 1 3 6 7% ,与第一个 2 5ml/kg的换出率对比 ,均有显著意义。换血量 (X)与胆红素下降 (Y)呈正相关 ,r=0 542 ,F =51 1 2 ,P <0 0 1。回归方程为Y =4 6 8 71 - 1 373X ,t =2 7 86 ,P <0 0 1。结论　 总胆红素的下降与换血量成正比关系 ,累计换出率逐渐增加 ,但每换血 2 5ml/kg的换出率无明显变化。根据回归方程可预测推算所需要的换血量或换血后胆红素的水平。

Again study on the relationship between the bilirubin and exchange transfusion volume via peripheral vessels

Objective Study the relationship between the bilirubin and exchange transfusion volume in hyperbilirubinaemia using peripheral vessels and revise the formula again. Methods Exchange transfusions were performed through the peripheral vessels on 19 cases of hyperbilirubinaemia. Total serum bilirubin (TSB), indirect bilirubin (IBili) and direct bilirubin (DBili) were measured before starting (0 ml/kg) and after exchanged per 25ml/kg. Results TSB and DBili were markedly decreased after exchange transfusion every 25 ml/kg, the clearance rates of TSB after exchanged per 25 ml/kg were between 6% and 11%, and had no marked significance. The clearance rates of TSB accumulated 50 ml/kg, 75 ml/kg, 100 ml/kg, 125 ml/kg, 150 ml/kg were 17.21%±8.52%, 26.13%±10.11%, 30.02%±10.67%, 36.82%±13.17%, 43.65%±13.67%, compared exchange transfusion 25 ml/kg they all have marked significance. The exchange transfusion volume (X) was perfect positive correlation with TSB(Y)(r=0.542, P<0.01). The linear regression equation was: Y=468.71-1.373X. Conclusion The exchange transfusion volume was perfect positive correlation with TSB, accumulated clearance rates rose gradually, but the clearance rates per 25 ml/kg were near. Exchange transfusion volume and the concentration of TSB after finishing can be prediction using the linear regression equation.