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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(Sa O2)。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 effectiveness and safety of sequential transfusion of suspended erythrocytes and plasma for transfusions of neonates. Methods From October 2006 to September 2013, children with severe hyperbilirubinaemia requiring transfusion therapy in our department were randomly divided into the control group and the observation group. The control group required the erythrocytes and plasma 1: 1 isokinetic infusion for the exchange of blood; observation group transfusion volume of the former 1/3, the infusion of plasma rate of double the rate of red blood cells, 1/3 when both infusion rate equal to 1/3 after infusion of red blood cell rate Twice as much as plasma. Before, during and after the change of blood, blood, electrolytes, blood glucose and serum bilirubin were detected, and vital signs and percutaneous oxygen saturation (Sa O2) were observed and recorded. Results The control group included 40 cases, the observation group included 42 cases. The levels of bilirubin in the two groups were significantly lower than those in the control group [(222.1 ± 30.3) μmol / L vs (455.5 ± 52.3) μmol / L, and 207.3 ± 27.8 μmol / L vs ± 48.6) μmol / L, P <0.001]. Compared with the control group, the level of bilirubin in the observation group was lower after transfusions (P <0.05), and the hemoglobin content in the observation group was significantly higher than that in the control group [(151 ± 22) g / L ratio (135 ± 26) g / L, P <0.01]. Two groups of children with transfusion-related complications, such as hyperglycemia, thrombocytopenia, hypocalcemia and hyponatremia, etc. can be returned to normal within a short time. Conclusions It is safe and effective to use the sequential adjustment of infusion rate of suspended erythrocytes and plasma for blood exchange without significantly increasing the amount of blood used, which can significantly reduce the level of bilirubin and anemia.