超低出生体重儿红细胞输注的临床分析

摘要

探讨超低出生体重(ELBW)儿减少红细胞输注的可能性。方法对1989～1997年9年间256例超低出生体重儿的红细胞输注进行临床分析。在此期间红细胞输注指征进行了3次制订，对检验样本的采血量进行了严格的控制，部分病例应用了重组人促红细胞生成素治疗。结果1994年以后有1/4的ELBW儿不需要输注红细胞，1989～1997年平均输血次数由7次降至2.7次(P＜0.01)。按出生体重累计红细胞输注量由163.5mL/kg降至69.2mL/kg(P＜0.01)，接受供血者人数由6.3人降至1.5人(P＜0.01)。红细胞输注前的平均红细胞压积比，机械通气者由0.43降至0.34、自主呼吸者由0.41降至0.31。ELBW儿更加不成熟，平均胎龄由27.4周减至26.0周，平均出生体重由833g降至741g。存活率仍达78％，住院时间没有延长，严重并发症如视网膜病、动脉导管未闭、脑室出血的发生率没有增加。结论制订严格的红细胞输注指征有助于减少输血次数和接受供血者人数，且患儿临床耐受良好。%To investigate the possibility of reducing red blood celltransfusions in extremely low birth weight infants. Methods We performed a single-center analysis of 256 infants with birth weights from 500 to 999g who were admitted from 1989 to 1997 and included 3 study periods,each starting with newly modified transfusion guidelines in April 1989, September 1991, and January 1995. We evaluated previously recorded clinical data and retrospective chart analysis for transfusion-related information. Results Although nearly all infants received one or more red blood cell transfusions during the first 2 study periods,approximately one quarter received no transfusion during the last period. The mean number of transfusions per infant decreased from 7 in the first period to 2. 7 in the third period, whereas donor exposure decreased from 6. 3 to 1.5 and blood volume transfused decreased from 163.5 to 69. 2mL/kg birth weight( P＜ 0. 01 ). The overall survival rate was 78% and hospital stay didn't prolong. The incidences of retinopathy,intraventricular hemorrhage,and patent ductus arteriosus remained unchanged. Conclusions Over this 9-year period with increasingly restricitive transfusion guidelines,the transfusion number and the donor exposure decrease significantly in ELBW infants without adverse clinical effects.