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

摘要

Objective To identify risk factors of thrombocytopenia caused by the exchange transfusion in the treatment of neonates with severe hyperbilirubinemia.Methods A retrospective study was conducted among 528 neonates of the exchange transfusion in the treatment of severe hyperbilirubinemia.Of the treated neonates,127 cases had thrombocytopenic after exchange transfusion (study group).127 neonates with normal platelet count after treatment were randomly selected as controls.Risk factors of thrombocytopenia were explored.Results The rate of thrombocytopenia was as high as 24.05％ after the exchange transfusion (127/528 cases).Among the 127 cases with thrombocytopenia,89 patients (70.1％) had platelet of 50 × 109/L or higher,31 patients (24.4％) had platelet of 20-50 × 109/L,and the remaining 7 (5.52％) had platelet ＜ 20 × 109/L.There were significant differences in age,total bilirubin,intracranial hemorrhage or cephalhematoma,and metabolic acidosis following blood exchange transfusion between the two groups.Conclusion Age,total bilivubin,intracranial hemorrhage or cephalhematoma,and metabolic acidosis following blood exchange transfusion were risk factors of thrombocytopenia caused by the exchange transfusion in the treatment of neonates with severe hyperbilirubinemia.%目的 探讨新生儿严重高胆红素血症换血治疗后,引起血小板减少症的危险因素.方法 采用回顾性研究方法,经换血治疗的新生儿严重高胆红素血症患儿528例,换血后出现血小板减少症127例,换血后血小板计数正常401例,随机选取127例为对照组,利用Logistic回归分析血小板减少症临床资料的危险因素.结果 换血后新生儿血小板减少症发生率高达24.1％(127/528例),血小板计数≥50×109/L占70.1％,血小板计数20～ 50×109/L占24.4％,血小板计数＜20×109/L占5.5％.换血时日龄[OR=1.213,95％ CI(1.028,1.417)]、换血前总胆红素值[OR=1.172,95％ CI(1.051,1.309)]、颅内出血或头颅血肿[OR =5.594,95％ CI(3.257,11.121)]、换血后酸中毒OR =7.246,95％ CI(4.797,12.188),4项因素为换血后血小板减少症的危险因素.结论 患儿换血时日龄、换血前总胆红素值、合并颅内出血或头颅血肿、换血后酸中毒是换血治疗新生儿严重高胆红素血症后引起血小板减少症的危险因素.