外周动静脉同步换血治疗新生儿高胆红素血症的临床研究

目的 评价外周动静脉同步换血疗法治疗新生儿重症高胆红素血症的效果及安全性,探讨其适应症及对临床的指导意义.方法 采用外周动静脉同步换血术治疗96例高间接胆红素血症患儿,比较其换血前后血常规、胆红素、电解质、凝血功能及血糖水平的变化,监测换血后神经系统症状体征及血常规、胆红素的变化情况.结果 换血术后血清总胆红素平均下降48.6%,以间接胆红素为主,白细胞、血小板、血钾均有下降(P<0.01),红细胞、血红蛋白及血糖明显上升(P<0.01),血钙、钠、镁及氯无明显变化(P>0.05),纤维蛋白原下降(P<0.01),异常的活化部分凝血酶原时间恢复正常.凝血酶原时间及凝血酶时间无明显变化(P>0.05),术中有个别病例发生呼吸减慢及心血管功能障碍,术后有坏死性小肠结肠炎发生.结论 外周动静脉同步换血疗法疗效好,安全性高,操作简单,但术中术后的严密监测仍是必要的.

Study on the treatment of severe neonatal hyperbilirubinemia by peripheral arteriovenous synchronous exchange transfusion

Objective To evaluate the efficacy, safety, and then understand the indication, clini-cal application of the peripheral arteriovenous synchronous exchange transfusion therapy on the infants with severe neonatal hyperbilirubinemia. Methods peripheral arteriovenous synchronous exchange transfusion was performed on 96 newly-born infants with hyperbilirnbinaemia. The changes of their blood routine, serum bilirubin, electrolyte, coagulation functions and blood glucose before and after the exchange transfusion were analyzed and the neurological symptoms, blood routine and serum bilirubin were continuously observed after treatment. Results The average decrease in serum total bilirubin concentration was 48.6%, mainly in indirect bilirubin, after exchange transfusion. Levels of leukocyte, template and serum potassium all had showed distinctive downtrend with P<0.01, but levels of Erythrocyte, hemoglobin and blood glucose increased statistically with P<0.01 after the operation. Serum calcium, sodium, magnesium and chlorine did not change significantly with P> 0.05 through the treatment. The analysis of coagulation functions showed that both fibrinogen and active partial thromboplastin time decreased signifi-cantly with P<0.01, but prothrombin time and thrombin time had no significant change with P> 0.05 compared with itself before the exchange transfusion. Respiration/circulation suppression or necrotizing enterocolitis only oc-curred in individual cases. Conclusions Peripheral arteriovenous synchronous exchange transfusion has the advantages of good efficacy, safety find simple operation, but it is necessary to pay close attention on patients' life sign during and after the treatment.