控制成分输血输注速率提高新生儿换血疗效

摘要

目的 探讨序贯调节悬浮红细胞和血浆输注速率进行新生儿换血的有效性及安全性.方法 选择2006年10月至2013年9月我科收治的需要进行换血治疗的严重高胆红素血症患儿,随机分为对照组和观察组,对照组将所需红细胞与血浆按1∶1等速输注进行换血;观察组换血总量前1/3时,输注血浆速率为红细胞的两倍,中1/3时二者输注速率相等,后1/3时输注红细胞速率为血浆的两倍.换血前、中、后检测血常规、电解质、血糖及血胆红素等指标,并密切观察和记录患儿生命体征及经皮血氧饱和度(SaO2).结果 对照组纳入40例,观察组纳入42例.两组患儿换血治疗后胆红素水平均明显降低[对照组:(222.1±30.3)μmol/L比(455.5±52.3) μmol/L,观察组:(207.3±27.8) μmol/L比(451.2±48.6) μmol/L,P＜0.001],与对照组比较,观察组换血后胆红素水平更低,差异有统计学意义(P＜0.05);观察组换血后血红蛋白含量明显高于对照组[(151 ±22)g/L比(135±26)g/L,P＜0.01].两组患儿换血相关并发症,如高血糖、血小板减少、低钙血症和低钠血症等均可在短时间内恢复正常.结论 采用序贯调节悬浮红细胞和血浆的输注速率进行换血,在不增加用血量基础上,能明显降低胆红素水平和贫血的发生,且安全有效.%Objective To investigate the efficacy and safety of exchange transfusion in infants with severe neonatal hyperbilirubinaemia through control of the speed of component transfusion.Methods Eighty-two neonates requiring exchange transfusion due to severe hyperbilirubinaemia admitted between October 2006 and September 2013 were randomly divided into 2 groups.In the control group,40 neonates were exchange transfused with RBCs and fresh frozen plasma (FFP) simultaneously at the same infusion rates.In the observation group (42 neonates),FFP was infused at twice the rate of RBCs during the first 1/3 of transfusion volume; during the second 1/3 of transfusion,FFP and RBCs were infused at the equal rate; during the last 1/3 of transfusion,RBCs was infused at twice the rate of FFP.Serum bilirubin,hemoglobin (Hb),serum electrolyte,and blood gas were compared before and after exchange transfusion.Vital signs and transcutaneous oxygen saturation (SaO2) were observed and recorded in the process.Results (1) ABO or Rh incompatibility was a major cause of exchange transfusion among infants with severe hyperbilirubinemia.(2) Exchange transfusion significantly reduced bilirubin levels in both groups [Control group:Pre-transfusion (222.1 ± 30.3) μ mol/L vs.Post-transfution(455.5 ± 52.3) μmol/L; Observation group:Pre-transfusion(207,3 ± 27.8) μmol/L vs.Post-transfusion(451.2 ± 48.6)μmol/L,P ＜ 0.001].(3) However,compared with infants in the control group,infants in the observation group experienced more prominent decrease of bilirubin level (P ＜0.05) as well as more significant increase of hemoglobin level post exchange transfusion [Observation group:Hb (151 ±22) g/L vs.Control group:Hb (135 ±26)g/L,P ＜0.01].(4) Major exchange transfusion related complications,such as hyperglycemia,thrombocytopenia,hyponatremia,hypocalcemia,were asymptomatic and reversible.Conclusions Sequential control of the transfusion rate of RBCs and FFP during exchange transfusion can safely decrease serum bilirubin level and prevent anemia without increasing the total transfusion volume of RBCs and FFP.