[1]许风芝,张红桃,王永明,等.不同的换血量治疗ABO溶血致新生儿高胆红素血症的疗效及其对血液指标的影响[J].医学信息,2021,34(20):115-118.[doi:10.3969/j.issn.1006-1959.2021.20.029]
　XU Feng-zhi,ZHANG Hong-tao,WANG Yong-ming,et al.The Efficacy of Different Blood Exchange Volumes in the Treatment of Neonatal Hyperbilirubinemia Caused by ABO Hemolysis and its Influence on Blood Indexes[J].Medical Information,2021,34(20):115-118.[doi:10.3969/j.issn.1006-1959.2021.20.029]
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不同的换血量治疗ABO溶血致新生儿高胆红素血症的疗效及其对血液指标的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
34卷
期数:
2021年20期
页码:
115-118
栏目:
论著
出版日期:
2021-10-20

文章信息/Info

Title:
The Efficacy of Different Blood Exchange Volumes in the Treatment of Neonatal Hyperbilirubinemia Caused by ABO Hemolysis and its Influence on Blood Indexes
文章编号:
1006-1959（2021）20-0115-04
作者:
许风芝1; 张红桃2; 王永明3; 马利勇3
1.宁夏医科大学总医院新生儿科，宁夏 银川 750001；2.宁夏儿童医院PICU，宁夏 银川 750001；3.银川市妇幼保健院新生儿科，宁夏 银川 750001
Author(s):
XU Feng-zhi1; ZHANG Hong-tao2; WANG Yong-ming3; MA Li-yong3
1.Department of the Neonate,General Hospital of Ningxia Medical University,Yingchuan 750001,Ningxia,China;2.PICU,Ningxia Children’s Hospital,Yingchuan 750001,Ningxia,China;3.Department of the Neonate,Yinchuan Maternal and Child Health Care Hospital, Yingchuan 750001,Ningxia,China
关键词:
换血; 新生儿ABO溶血病; 新生儿高胆红素血症
Keywords:
Exchange transfusion; ABO hemolytic disease of newborn; Neonate hyperbilirubinemia
分类号:
R966
DOI:
10.3969/j.issn.1006-1959.2021.20.029
文献标志码:
A
摘要:
目的 观察不同剂量换血对ABO溶血导致新生儿高胆红素血症的疗效及对血液指标的改变的影响。方法 收集2013年6月-2020年5月在宁夏医科大学总医院和银川市妇幼保健院收治的81例确诊为新生儿ABO溶血病、新生儿高胆红素血症的足月新生儿，采用随机数字表法分为A组、B组和C组，每组27例。三组分别给予3∶1重组血换血治疗，换血量分别为单倍量、双倍量、三倍量。比较换血前后血清总胆红素、白细胞、血红蛋白、血小板、血糖、平均动脉压、心率、电解质（钾、钠、氯、钙）、血清白蛋白，分析三组患儿二次换血比例。结果 与换血前比较，换血后血清总胆红素、白细胞、血小板、血清白蛋白、血清钠离子、平均动脉压下降，血糖、心率升高（P＜0.05）；换血前后血清氯离子、血清钙离子、血清钾离子及血红蛋白比较，差异无统计学意义（P＞0.05）；换血后三组血清总胆红素、白细胞、血小板、血清钠离子、血清白蛋白、平均动脉压由高到低依次为A组、B组、C组，血糖和心率由高到低依次为C组、B组、A组（P＜0.05），但三组血红蛋白、血清钾离子、血清氯离子、血清钙离子水平比较，差异无统计学意义（P＞0.05）；A组二次换血占比高于C组（P＜0.05）。结论 使用双倍量换血能有效降低由ABO溶血导致新生儿高胆红素血症的血清胆红素值，并能降低再换血比例，三倍量后并未减少二次换血比例。
Abstract:
Objective To observe the efficacy of different blood exchange volumes in the treatment of neonatal hyperbilirubinemia caused by ABO hemolysis and its influence on blood indexes.Methods A total of 81 full-term newborns diagnosed with ABO hemolytic disease and neonatal hyperbilirubinemia from June 2013 to May 2020 were collected in the General Hospital of Ningxia Medical University and Yinchuan Maternal and Child Health Hospital. They were divided into three groups ( A, B and C ) by random number table method, with 27 in each group. The three groups were treated with 3 ∶ 1 recombinant blood exchange, and the blood exchange volume was single, double and triple. Serum total bilirubin, white blood cells, hemoglobin, platelet, blood glucose, mean arterial pressure, heart rate, electrolyte ( potassium, sodium, chlorine, calcium ) and serum albumin were compared before and after blood exchange, and the proportion of secondary blood exchange in the three groups was analyzed.Results Compared with before blood exchange, serum total bilirubin, white blood cells, platelets, serum albumin, serum sodium ion, mean arterial pressure decreased, blood glucose and heart rate increased after blood exchange (P<0.05). There was no significant difference in serum chloride ion, serum calcium ion, serum potassium ion and hemoglobin before and after blood exchange (P>0.05). After blood exchange, the serum total bilirubin, white blood cells, platelets, serum sodium ion, serum albumin and mean arterial pressure in the three groups from high to low were group A, group B and group C, and the blood glucose and heart rate from high to low were group C, group B and group A (P<0.05), but there was no significant difference in hemoglobin, serum potassium, serum chloride and serum calcium among the three groups (P>0.05). The proportion of secondary blood exchange in group A was higher than that in group C (P<0.05).Conclusion Double blood exchange volumes can effectively reduce the serum bilirubin value of neonatal hyperbilirubinemia caused by ABO hemolysis, and can reduce the proportion of re-blood exchange. The proportion of secondary blood exchange volume does not decrease after triple blood exchange volumes.

参考文献/References:

[1]Ullah S,Rahman K,Hedayati M.Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article[J].Iran J Public Health,2016,45(5):558-568.[2]中华医学会儿科学分会新生儿学组.新生儿高胆红素血症诊断与治疗专家共识[J].中华儿科杂志,2014, 52(10):320-326.[3]Magai DN,Mwaniki M,Abubakar A,et al.A randomized control trial of phototherapy and 20% albumin versus phototherapy and saline in Kilifi, Kenya[J].BMC Res Notes,2019,12(1):617.[4]Singla DA,Sharma S,Sharma M,et al.Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia and Neurotoxicity in Neonates from Hilly Terrain of India[J].Int J Appl Basic Med Res,2017,7(4):228-232.[5]Hung TW,Tsa JD,Pan HH,et al.Is Neonatal Hyperbilirubinemia Exposure Associated with a Risk of Autism Spectrum Disorder? A Nationwide Cohort Study[J].Am J Perinatol,2020:32168527.[6]Karimzadeh P,Fallahi M,Kazemian M,et al.Bilirubin Induced Encephalopathy[J].Iran J Child Neurol,2020,14(1):7-19.[7]Amin SB,Saluja S,Saili A,et al.Auditory toxicity in late preterm and term neonates with severe jaundice[J].Dev Med Child Neurol,2017,59(3):297-303.[8]Xu J,Weng M,Li N,et al.Relationship research between auditory neuropathy spectrum disorder and exchange transfusion in neonates with severe hyperbilirubinemia[J].Int J Pediatr Otorhinolaryngol,2019(123):146-150.[9]翟韶蕊,吴艳梅,邓国良.高胆红素血症新生儿应用单、双倍血量换血治疗的效果对比分析[J].医学检验与临床,2018,29(10):49-57.[10]雷贤明,胡敏,刘佳,等.外周动静脉同步换血疗法治疗重度新生儿高胆红素血症96例临床分析[J].吉林医学,2017,38(11):2136-2138.[11]American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation[J].Pediatrics,2004,114(4):297-316.[12]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学(第五版)[M].北京:人民卫生出版社,2019:464-796.[13]Alkén J,Hakansson S,Ekeus C,et al.Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden[J].JAMA Netw Open,2019,2(3):e190858.[14]Ballot DE,Rugamba G.Exchange Transfusion for Neonatal Hyperbilirubinemia in Johannesburg, South Africa, from 2006 to 2011[J].Int Sch Res Notices,2016(2016):1268149.[15]Kim MS,Chung Y,Kim H,et al.Neonatal exchange transfusion: Experience in Korea[J].Transfus Apher Sci,2020,59(3):102730.[16]Kakkar B,Agrawal S,Chowdhry M,et al.Exchange transfusion in neonatal hyperbilirubinemia: A single Centre experience from Northern India[J].Transfus Apher Sci,2019,58(6):102655.[17]刘玲,杨跃煌,刘红林,等.严重高胆红素血症新生儿换血治疗后血小板减少症的危险因素[J].中国生育健康杂志,2017,28(3):233-236.[18]Yu C,Li H,Zhang Q,et al.Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during 11 years, from 2001 to 2011[J].PLoS One,2017,12(6):e0179550.[19]Malla T,Singh S,Poudyal P,et al.A Prospective Study on Exchange Transfusion in Neonatal Unconjugated Hyperbilirubinemia--in a Tertiary Care Hospital, Nepal[J].Kathmandu Univ Med J (KUMJ),2015,13(50):102-108.[20]Behjati SH,Sagheb S,Aryasepehr S,et al.Adverse events associated with neonatal exchange transfusion for hyperbilirubinemia[J].Indian J Pediatr,2009,76(1):83-85.

更新日期/Last Update: 1900-01-01