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目的探讨高球浆比换血治疗新生儿重度高胆红素血症的安全性和疗效。方法将去白浓缩红细胞与血浆按(2—3)∶1混合,对确诊的58名重度高胆红素血症患儿做外周动静脉同步换血治疗,其中ABO系统溶血病27例、Rh系统溶血病12例、严重感染11例、遗传性红细胞增多症2例和原因不明6例,换血总量约180 ml/kg;换血过程中予以生命体征监护,监测换血前后胆红素、总胆红素/白蛋白(B/A)比值、血常规、电解质、血生化指标的变化。结果患儿换血前总胆红素水平(476.2±123.1)μmol/L,换血后降为(219.7±85.5)μmol/L、B/A比值由12.53降为6.47,平均降低了50%,差异具统计学意义(P<0.01)。换血治疗后,患儿白细胞、血小板计数均有所降低,血红蛋白和红细胞无明显下降。血电解质中Ca2+下降明显,由(2.41±0.27)mmol/L降低至(1.29±0.33)mmol/L,其他指标无明显变化。临床痊愈出院55例,3例因不良神经预后放弃继续治疗。结论采用高球浆比同步换血治疗新生儿重度高胆红素血症疗效好,操作简便、安全,是治疗新生儿重度高胆红素血症的一种有效方法。
Objective To investigate the safety and efficacy of high-plasma-to-liquid-exchange transfusion in the treatment of severe neonatal hyperbilirubinemia. Methods The leukocyte-depleted erythrocytes and plasma were mixed according to (2-3): 1. Peripheral arterial and venous transfusions were performed in 58 children with severe hyperbilirubinemia. Among them, 27 cases were hemolytic disease of ABO system, Rh system Hemolytic disease in 12 cases, 11 cases of severe infection, 2 cases of hereditary polycythemia and 6 cases of unknown cause, the total exchange of blood about 180 ml / kg; during the exchange of blood to take vital signs monitoring, monitoring before and after transfusion bilirubin, total bilirubin (B / A) ratio, blood routine, electrolytes and blood biochemical parameters. Results The level of total bilirubin before transfusions was (476.2 ± 123.1) μmol / L in children and 219.7 ± 85.5 μmol / L in transfusions, and the B / A ratio decreased from 12.53 to 6.47 with an average reduction of 50% Statistical significance (P <0.01). After the exchange of blood treatment, children with leukocytes, platelet count decreased, no significant decline in hemoglobin and red blood cells. The level of Ca2 + in blood electrolytes decreased significantly from (2.41 ± 0.27) mmol / L to (1.29 ± 0.33) mmol / L, while there was no significant change in other indexes. 55 cases were discharged from the clinic, and 3 cases were given up because of poor neurological prognosis. Conclusions The treatment of severe hyperbilirubinemia with neonatal hyperosermia by high ratio of plasma-to-blood transfusion is effective, simple, and safe. It is an effective method for the treatment of severe hyperbilirubinemia in neonates.