Objective To compare the clinical efficacy between single and double volume exchange transfusion for neonatal hyperbilirubinemia,and to verify whether single volume exchange transfusion had advantages in maintaining homeostasis and reducing blood transfusion related complications.Methods Clinical materials of 86 neonates with neonatal hyperbilirubinemia who received blood exchange transfusion,from December 2013 to December 2014,in the diagnosis and treatment center of our hospital were retrospectively analyzed.Cases were divided into the single volume group (35 cases,with a blood volume 80-110 mL/kg) and double volume group (51 cases,with a blood volume 150-180 mL/kg) based on blood volume per kilogram of body weight.Comparisons of the homeostasis changes between pre-transfusion and post-transfusion were performed for each group,and the incidence rate of major adverse events were compared between the two groups.Results (1)In the single volume group and double volume group,the average blood exchange transfusion volumes were (98.16 ± 10.75) mL/kg and (157.78 ± 7.37) mL/kg,the exchange rate of bilirubin were (41.68± 8.52) ％ and (50.22 ± 13.14) ％,and the average time for blood transfusion were (85.60 ±18.66) min and(1 1B.22± 24.81)min respectively,and there were statistically significant differences in the exchange rate of bilirubin and average time for blood transfusion between the two groups (P＜0.05).(2)Compared with pre-transfusion,WBC and platelet (PLT)count,levels of serum total bilirubin (TBIL),albumin,serum potassium,serum sodium,serum chlorine,serum calcium and HCO3-,and pH value were significantly decreased after blood exchange transfusion,while RBC count,PT,APTT and blood glucose were significantly increased in the two groups (P＜0.01).Moreover,the changes of blood glucose,PLT and TBIL in the double volume group were more significantly than those in the single volume group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in the rate of major adverse events between the two groups (P＞0.05).Conclusion Compared with double blood exchange transfusion therapy,single volume exchange transfusion can significantly decrease plasmic bilirubin level with less change of homeostasis,less blood volume for transfusion and less human resources consumption,its value in clinical application is recognized.%目的 比较单、双倍血量换血在新生儿高胆红素血症中的治疗效果,明确单倍血量换血在减少内环境波动、降低换血相关并发症中是否具有明显优势.方法 回顾性分析该院新生儿诊治中心2013年12月至2014年12月行换血治疗的86例高胆红素血症患儿临床资料,以单位体质量换血量将其分为单倍换血量组(80～110 mL/kg,35例)及双倍换血量组(150～180 mL/kg,51例),比较两组换血前、后内环境的变化情况及不良事件的发生率.结果 (1)单倍换血量组与双倍换血量组的换血量分别为(98.16士10.75)、(157.78±7.37)mL/kg,胆红素换出率分别为(41.68士8.52)％、(50.22±13.14)％,换血时间分别为(85.60士18.66)、(118.22士24.81)min,两组胆红素换出率与换血时间比较,差异均有统计学意义(P＜0.05).(2)两组患儿换血后白细胞(WBC)、血小板(PLT)计数、血清总胆红素(TBIL)、清蛋白、血钾、血钠、血氯、血钙、碳酸氢盐(HCO3-)水平及pH值均低于换血前,红细胞(RBC)计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及血糖水平均高于换血前,差异均有统计学意义(P＜0.01),其中双倍换血量组换血后血糖、PLT、TBIL变化较单倍换血量组更大,差异有统计学意义(P＜0.05).两组患儿换血相关不良事件发生率比较,差异无统计学意义(P＞0.05).结论 与双倍量换血相比,单倍量换血对内环境影响较小,用血量及人力消耗较少,能明显降低血清胆红素水平,具有较好的临床应用价值.
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