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目的探讨影响新生儿高胆红素血症双管同步换血疗法疗效及不良事件发生的因素。方法回顾性分析重庆医科大学附属儿童医院新生儿诊治中心2006年6月-2009年6月收治的160例经外周动静脉双管同步换血治疗的高胆红素血症患儿的临床资料。不良事件定义为发生如下情况之一:换血过程中发生血氧饱和度曾低于85%并持续5 min以上,发生低血压、呼吸暂停或抑制、心率低于100次.min-1并持续5 min以上。分析换血前患儿的疾病状态、内环境指标、换血量及换血速度对不良事件的影响。结果本研究中不良事件发生率为30.63%(49/160例)。换血过程中有不良事件组新生儿的肺动脉高压患病率高于无不良事件组(8.2%vs0,P=0.008),有不良事件组患儿换血前血清钾、钠、氯、钙及镁离子水平、Hb水平与无不良事件组比较差异均无统计学意义(Pa>0.05),2组单位体质量换血量、单位时间单位体质量换血量比较差异也均无统计学意义(Pa>0.05)。胆红素下降数值与单位体质量换血量呈正相关(r=0.330,P=0.000),与换血前胆红素数值呈正相关(r=0.829,P=0.000)。结论影响换血疗法治疗新生儿高胆红素血症胆红素下降幅度的因素为单位体质量换血量及换血前胆红素水平;影响不良事件发生的主要因素为肺动脉高压。
Objective To explore the effect of double-tube simultaneous blood transfusion therapy on the neonatal hyperbilirubinemia and the factors affecting the occurrence of adverse events. Methods The clinical data of 160 patients with hyperbilirubinaemia treated by exchanging peripheral arterial and venous double tubes simultaneously from June 2006 to June 2009 were retrospectively analyzed in neonatal diagnosis and treatment center of Children’s Hospital Affiliated to Chongqing Medical University. Adverse events were defined as one of the following conditions: blood oxygen saturation occurred during the exchange of less than 85% for 5 min or more, hypotension, apnea or inhibition, heart rate less than 100 times. Min-1 for 5 min or more. Analysis of pre-transfusion in children with disease status, internal environmental indicators, blood exchange and blood exchange rate of adverse events. Results The incidence of adverse events in this study was 30.63% (49/160 cases). In the adverse event group, the prevalence of pulmonary hypertension was significantly higher in neonates with adverse events than in those without adverse events (8.2% vs0, P = 0.008). There were significant differences in serum potassium, sodium, chloride, calcium and magnesium (P> 0.05). There was no significant difference between the two groups in the exchange of blood volume per unit body weight and the exchange of blood volume per unit body weight (Pa> 0.05) 0.05). The value of bilirubin descended positively with unit exchange volume (r = 0.330, P = 0.000), and positively correlated with the value of bilirubin before exchange (r = 0.829, P = 0.000). Conclusions The factors influencing the decline of bilirubin in transfusion therapy for neonatal hyperbilirubinemia are the transfusion volume per unit body mass and the level of bilirubin before transfusion; the main factor affecting the occurrence of adverse events is pulmonary hypertension.