不同球浆比例换血治疗新生儿重症高胆红素血症的研究(1)
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[摘要] 目的 探讨不同比例的红细胞与血浆换血对新生儿重症高胆红素血症的疗效。 方法 将55例高胆红素血症需换血的新生儿随机分为3组，采用红细胞与血浆换血1∶1组20例， 2∶1组19例，2.5∶1组16例。换血量按(150～180) mL/kg双倍量换血。其中1∶1组、2∶1组换血结束后常规输注浓缩红细胞(15～20) mL/kg，2.5∶1组换血结束后不再常规输注浓缩红细胞，监测换血前后血清总直接胆红素、红细胞数量、血红蛋白、红细胞压积的变化。 结果 同组换血前及换血后总胆红素、间接胆红素有显著变化(P < 0.05)，1∶1组、2∶1组换血后红细胞数量、血红蛋白、红细胞压积均下降(P < 0.05)，而2.5∶1组换血后红细胞数量、血红蛋白、红细胞压积无明显下降(P > 0.05)；换血后三组间比较，1∶1组及2∶1组红细胞数量、血红蛋白、红细胞压积较2.5∶1组明显下降(P < 0.01)，其中1∶1组红细胞数量、血红蛋白、红细胞压积较2∶1组下降更明显(P < 0.01)。 结论 2.5∶1组换血后贫血发生率更低，2.5∶1球浆比例组合较2∶1、1∶1球浆比例组合换血更适合新生儿高胆红素换血的临床需要。
[关键词] 高胆红素血症；换血；球浆比例；新生儿
[中图分类号] R722.1 [文献标识码] B [文章编号] 1673—9701(2012)27—0050—02
Different proportions red blood cell vs plasma exchange transfusion on neonate severe hyperbilirubinemia
SHEN Yucai HUANG Weiben CHAO Weicong ZHENG Zhiling CHAO Liuyan XU Lirong
Department of Neonatology，Guangdong Province Conghua City Central Hospital，Conghua 510900， China
[Abstact] Objective To investigate the different proportions of RvsP(RvsP，Red blood cellvsplasma) exchange transfusion on neonate severe hyperbilirubinemia. Methods Fifty—five newborn infants with severe hyperbilirubinemia by exchange transfusion with different proportion of mixed blood(red blood cell and plasma)，were randomly into three groups：20 patients were in the 1∶1 group，19 patients were in the 2∶1 group， 16 patients were in the 2.5∶1 group.All of 55 patients received double exchange transfusion in accordance (150～180) mL/kg. After exchange transfusion，patients in the 1∶1 group and 2∶1 group received RBCs with (15～20) mL/kg，while patients in the 2.5∶1 group did not.The indicators，which included total serum birubin(TB)， direct bilirubin(IB)，red blood cell count(RBC)，hemoglobin(HGB)，hematocrit(HCT). Results In the same group， TB，IB were declined after the exchange transfusion(P < 0.05)，RBC，HGB，HCT in 1：1group and 2∶1 group were declined after exchange transfusion(P < 0.05).However，in the 2.5∶1 group，RBC，HGB，HCT were no obvious decline after exchange transfusion(P > 0.05)，After exchange transfusion，RBC，HGB，HCT were lower in 1：1 group and 2∶1 group than that in 2.5∶1 group(P < 0.01)，RBC，HGB，HCT in 1∶1 group were even lower than that in group 2∶1(P < 0.01).Conclusion The rate of anemia in 2.5∶1 group was lower than that of 1∶1 group and 2∶1 group after exchange transfusion，therefore，2.5∶1(the RBCs vs plasma) is more suitable for the clinical needs in exchange transfusion process.
[Key words] Hyperbilirubinemia；Exchange transfusion；Red blood cell vs plasma；Newborn infant
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