高球浆比换血治疗新生儿重度高胆红素血症

目的探讨高球浆比换血治疗新生儿重度高胆红素血症的安全性和疗效。方法将去白浓缩红细胞与血浆按(2—3)∶1混合,对确诊的58名重度高胆红素血症患儿做外周动静脉同步换血治疗,其中ABO系统溶血病27例、Rh系统溶血病12例、严重感染11例、遗传性红细胞增多症2例和原因不明6例,换血总量约180 ml/kg;换血过程中予以生命体征监护,监测换血前后胆红素、总胆红素/白蛋白(B/A)比值、血常规、电解质、血生化指标的变化。结果患儿换血前总胆红素水平(476.2±123.1)μmol/L,换血后降为(219.7±85.5)μmol/L、B/A比值由12.53降为6.47,平均降低了50%,差异具统计学意义(P<0.01)。换血治疗后,患儿白细胞、血小板计数均有所降低,血红蛋白和红细胞无明显下降。血电解质中Ca2+下降明显,由(2.41±0.27)mmol/L降低至(1.29±0.33)mmol/L,其他指标无明显变化。临床痊愈出院55例,3例因不良神经预后放弃继续治疗。结论采用高球浆比同步换血治疗新生儿重度高胆红素血症疗效好,操作简便、安全,是治疗新生儿重度高胆红素血症的一种有效方法。

Exchange transfusion using high erythrocyte to plasma ratio for severe neonatal hyperbilirubinemia

Objective To investigate the effectiveness and safety of exchange transfusion with high ratio of hemocyte to plasma for treatment of severe neonatal hyperbilirubinemia.Methods A total of 58 neonates with severe hyperbilirubinemia recieved exchange transfusion of erythrocytes and plasma at a ratio of 2—3 to 1.Patients include 27 cases of ABO hemolytic disease,12 cases with Rh hemolytic disease,11 cases of severe infection,2 cases of hereditary spherocytosis,and 6 cases of unknown causes.The total amount of exchange transfusion was 180 ml/kg.Blood cell counts,serum electrolytes,serum bilirubin level and the ratio of total bilirubin / albumin(B/A) were analyzed before and after exchange transfusion.Results There was significant difference,with 50% decrease,in serum bilirubin level,and the ratio of B/A(t=28.334,P<0.001;t=9.49,P<0.01).White cell counts,platelet counts,and the calcium level decreased after exchange transfusion.The levels of other electrolytes were kept stable.A total of 55 patients were cured,while continuing treatment for the other 3 patients were given up because of the poor neurological outcomes.Conclusion Exchange transfusion is safe and effective for the neonates with severe hyperbilirubinemia.