同步动静脉交换在新生儿ABO溶血中的应用

中国基层医药 Pub Date : 2020-04-01 DOI:10.3760/CMA.J.ISSN.1008-6706.2020.07.012

Sui Xu, R. Fu, Li-ping Chen, Wenqing Lu, Changhong Yan, Ying-bin Jiang, Lin Li, Qiao-Ling Wang

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In the exchange group, peripheral venous blood was collected half an hour before the exchange of blood(T1) and half an hour after the exchange of blood(T2), while in the control group, the indirect bilirubin, platelet and blood sugar were measured at two time points of parents signing disapproval of exchange of blood(T1) and disapproval of exchange of blood and one day after the treatment(T2). \n \n \nResults \nThe indirect bilirubin levels in serum of the exchange group and the control group were decreased, and the difference was statistically significant[(194.010±41.065)μmol/L vs.(390.048±39.058)μmol/L, t=1507.604, (292.014±39.998)μmol/L vs.(383.452±42.820)μmol/L, t=306.820, all P<0.05]. The decrease of serum indirect bilirubin in the exchange group was more significant than that in the control group, and the difference was statistically significant.[(194.010±41.065)μmol/L vs.(292.014±39.998)μmol/L, t=368.267, P<0.05]. After exchange transfusion, the levels of platelet and blood sugar were decreased significantly, and the differences were statistically significant[(91.370±24.766)×109/L vs.(350.660±32.564)×109/L, t=5061.203, (2.965±0.593)mmol/L vs.(5.490±0.876)mmol/L, t=717.817, all P<0.05]. 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引用次数: 0

摘要

目的通过比较换血前后血清和内环境间接胆红素的变化，评价换血对新生儿ABO溶血的影响。方法对江西省儿童医院2017年1月至2018年10月收治的242例新生儿ABO溶血病进行回顾性分析。根据父母是否签字或同意换血，他们被分为两组。交换组（126例）接受常规治疗+血液交换，对照组（116例）仅接受常规治疗（蓝光+益生菌+丙种球蛋白）。在换血组中，在换血前半小时（T1）和换血后半小时（T2）采集外周静脉血，而在对照组中，分别在父母签署不同意换血（T1）、不同意换药的两个时间点和治疗后一天（T2）测量间接胆红素、血小板和血糖。结果交换组和对照组血清间接胆红素水平均明显下降，差异有统计学意义[（194.010±41.065）μmol/L对（390.048±39.058）μmol/L，t=1507.604，（292.014±39.998）μmol/L与（383.452±42.820）μmol/L、t=306.820，均P<0.05]。[（194.010±41.065）μmol/L与（292.014±39.998）μmol/L，t=368.267，P<0.05]，差异有统计学意义[（91.370±24.766）×109/L与（350.660±32.564）×109g/L，t=5061.203，（2.965±0.593）mmol/L与（5.490±0.876）mmol/L，t=717.817，均P<0.05]。结论交换治疗可显著降低新生儿ABO溶血胆红素水平和胆红素脑病的发生率。交换疗法对新生儿ABO溶血患者的内环境有一定影响，易引起血小板减少和血糖降低。但内部环境的变化是暂时的、可逆的。关键词：新生儿；ABO溶血病；高胆红素血症；光疗；换血；疗效；影响力；胆红素脑病

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Application of synchronous arteriovenous exchange in neonatal ABO hemolysis

Objective To evaluate the effect and influence of exchange transfusion on neonatal ABO hemolysis by comparing the changes of indirect bilirubin in serum and internal environment before and after exchange transfusion. Methods A retrospective analysis of 242 cases with neonatal ABO hemolytic disease from January 2017 to October 2018 in the Children's Hospital of Jiangxi Province was carried out.According to whether the parents signed or agreed to exchange transfusion, they were divided into two groups.The exchange group (126 cases) received routine treatment + exchange of blood, and the control group (116 cases) was only given conventional therapy(blue light + probiotics + gamma globulin). In the exchange group, peripheral venous blood was collected half an hour before the exchange of blood(T1) and half an hour after the exchange of blood(T2), while in the control group, the indirect bilirubin, platelet and blood sugar were measured at two time points of parents signing disapproval of exchange of blood(T1) and disapproval of exchange of blood and one day after the treatment(T2). Results The indirect bilirubin levels in serum of the exchange group and the control group were decreased, and the difference was statistically significant[(194.010±41.065)μmol/L vs.(390.048±39.058)μmol/L, t=1507.604, (292.014±39.998)μmol/L vs.(383.452±42.820)μmol/L, t=306.820, all P<0.05]. The decrease of serum indirect bilirubin in the exchange group was more significant than that in the control group, and the difference was statistically significant.[(194.010±41.065)μmol/L vs.(292.014±39.998)μmol/L, t=368.267, P<0.05]. After exchange transfusion, the levels of platelet and blood sugar were decreased significantly, and the differences were statistically significant[(91.370±24.766)×109/L vs.(350.660±32.564)×109/L, t=5061.203, (2.965±0.593)mmol/L vs.(5.490±0.876)mmol/L, t=717.817, all P<0.05]. Decreased platelets and blood sugar could return to normal within 3 days. Conclusion Exchange therapy can significantly reduce the level of bilirubin and the incidence of bilirubin encephalopathy in neonates with ABO hemolysis.Exchange therapy has certain effect on the internal environment of neonatal ABO hemolytic patients, which is easy to cause thrombocytopenia and blood sugar reduction.But the change of internal environment is temporary and reversible. Key words: Neonate; ABO hemolytic disease; Hyperbilirubinemia; Phototherapy; Exchange transfusion; Curative effect; Influence; Bilirubin encephalopathy

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来源期刊

中国基层医药

CiteScore

0.10

自引率

0.00%

发文量

32251

期刊介绍： Since its inception, the journal "Chinese Primary Medicine" has adhered to the development strategy of "based in China, serving the grassroots, and facing the world" as its publishing concept, reporting a large amount of the latest medical information at home and abroad, prospering the academic field of primary medicine, and is praised by readers as a medical encyclopedia that updates knowledge. It is a core journal in China's medical and health field, and its influence index (CI) ranks Q2 in China's academic journals in 2022. It was included in the American Chemical Abstracts in 2008, the World Health Organization Western Pacific Regional Medical Index (WPRIM) in 2009, and the Japan Science and Technology Agency Database (JST) and Scopus Database in 2018, and was included in the Wanfang Data-China Digital Journal Group and the China Academic Journal Comprehensive Evaluation Database.