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目的探讨全自动换血术对高胆红素血症新生儿血液学指标的影响,评估其疗效与安全性以及间接胆红素和白蛋白比值的临床意义。方法 2008年1月至2010年5月南方医科大学南方医院对74例重症高胆红素血症患儿均采用周围动静脉同步换血术,监测换血前后胆红素、白蛋白、间接胆红素与白蛋白比值、电解质、血常规。结果血中胆红素、白蛋白、间接胆红素与白蛋白比值、电解质(Na+、K+、Cl-、Mg2+)、血常规换血后均较换血前明显下降,但Ca2+、P3+浓度换血后较换血前升高,差异均有统计学意义。换血术后无患儿发生不良反应。结论换血对胆红素、白蛋白、间接胆红素与白蛋白比值、Na+、K+、Cl-、Mg2+、Ca2+、P3+、白细胞、红细胞、血红蛋白、红细胞压积、血小板均有影响,应注意监测。特别要注意监测间接胆红素与白蛋白比值,该比值是评估胆红素毒性的危险指标。比值越高,其危险性越高,越需要输注白蛋白。
Objective To investigate the effect of automatic blood transfusion on the hematological indexes of newborns with hyperbilirubinemia and to evaluate its clinical efficacy and safety as well as the indirect bilirubin and albumin ratio. Methods From January 2008 to May 2010, 74 patients with severe hyperbilirubinaemia from Nanfang Hospital of Southern Medical University were enrolled in this study. Peripheral arterial and venous exchange transfusion was used to monitor bilirubin, albumin, indirect bilirubin Ratio to albumin, electrolytes, blood routine. Results The ratio of bilirubin, albumin, indirect bilirubin and albumin, electrolyte (Na +, K +, Cl-, Mg2 +) and blood exchange after blood exchange decreased significantly compared with that before blood exchange, but the concentrations of Ca2 + and P3 + Change before the exchange of blood, the differences were statistically significant. Transfusion without any adverse reactions in children. Conclusion Transfusion of blood on the bilirubin, albumin, indirect bilirubin and albumin ratio, Na +, K +, Cl-, Mg2 +, Ca2 +, P3 +, leukocytes, erythrocyte, hemoglobin, hematocrit, platelets are affected, should pay attention to monitoring . Particular attention should be paid to monitoring indirect bilirubin and albumin ratio, which is a risk indicator for assessing bilirubin toxicity. The higher the ratio, the higher the risk, the more the need for albumin infusion.