摘要
目的探讨新生儿重症高胆红素血症换血疗法严重不良反应的相关因素,为换血疗法的安全性提供依据。方法回顾性选取2001年5月至2018年5月重庆医科大学附属儿童医院新生儿中心收治的换血疗法后发生严重不良反应的重症高胆红素血症新生儿为不良反应组,按照1∶3配比选取同年换血疗法后未发生严重不良反应的重症高胆红素血症新生儿为对照组。分析两组患儿一般情况、合并疾病,换血前胆红素水平、急性胆红素脑病(acute bilirubin encephalopathy,ABE)评分、换血次数、换血过程中呼吸、心率、血压等变化。采用多因素Logistic回归模型分析重症高胆红素血症新生儿换血疗法后发生严重不良反应的相关因素。结果研究期间本院共收治接受换血疗法的重症高胆红素血症新生儿1 535例,累计换血1 583例次,发生换血相关严重不良反应71例(4.6%),累计发生换血相关严重不良反应85例次,主要为呼吸暂停26例次(30.6%),坏死性小肠结肠炎16例次(18.8%),心力衰竭12例次(14.1%),呼吸衰竭11例次(12.9%),休克7例次(8.2%),心动过缓5例次(5.9%),呼吸心跳骤停3例次(3.5%),应激性溃疡3例次(3.5%),弥散性血管内凝血1例次(1.2%),血压波动所致颅内出血1例次(1.2%)。多因素Logistic回归分析显示,ABE评分≥3分(OR=6.383,95%CI 2.550~15.979)、换血次数≥2次(OR=11.825,95%CI 2.464~56.755)、心脏杂音Ⅲ级及以上(OR=20.417,95%CI 4.705~40.590)、换血时收缩压波动≥30 mmHg(OR=13.612,95%CI 1.795~43.342)是重症高胆红素血症新生儿发生换血相关严重不良反应的独立危险因素(P<0.05)。结论换血前应谨慎评估换血指征,对于合并ABE评分≥3分、换血次数≥2次、心脏杂音Ⅲ级及以上,以及换血过程中收缩压波动≥30 mmHg的患儿,应做好充分准备,必要时终止换血。
Objective To study the risk factors of severe complications possibly associated with exchange transfusion (ET) for patients with extreme hyperbilirubinemia. Method From May 2001 to May 2018, neonates with severe complications of ET were assigned into adverse event group. The propensity score principle was used to match adverse event group/the control group with the ratio of 1∶3. The neonates in the control group received ET without any severe complications. The demographic characteristics of patients, and other clinical data were reviewed. The Logistic regression analysis was used to determine the risk factors of severe complications of ET. Result Among the 1 535 neonates who received ET during the past 17 years, 71 neonates (4.6%) were identified with severe adverse events, including apnea (30.6%), necrotizing enterocolitis (18.8%), heart failure (14.1%), respiratory failure (12.9%), and shock (8.2%). The Logistic regression analysis showed that acute bilirubin encephalopathy (ABE) score ≥ 3 (OR=6.383, 95%CI 2.550~15.979), ETs ≥ 2 times (OR=11.825, 95%CI 2.464~56.755), cardiac murmur ≥ grade Ⅲ(OR=20.417, 95%CI 4.705~40.590), and dramatic blood pressure fluctuation during ET ≥ 30 mmHg (OR=13.612, 95%CI 1.795~43.342) were risk factors of ET related severe complications (all P<0.05). Conclusion The indications should be carefully assessed before ET. The patients with ABE score ≥ 3, ETs ≥ 2 times, cardiac murmur ≥ grade Ⅲ, or dramatic blood pressure fluctuation during ET ≥ 30 mmHg should be monitored carefully and ET should be stopped in time if necessary.
作者
张倩男
刘开珍
李慧繁
何华云
华子瑜
Zhang Qiannan;Liu Kaizhen;Li Huifan;He Huayun;Hua Ziyu(Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China;Department of Obstetrics, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)
基金
重庆市科卫联合医学科研项目(2018MSXM063).
关键词
高胆红素血症
新生儿
危险因素
外周动静脉同步换血术
不良反应
Hyperbilirubinemia, neonatal
Risk factors
Peripheral ateriovenous synchronous exchange transfusion
Adverse event
作者简介
通信作者:华子瑜 Email:h_ziyu@126.com.
