摘要
目的观察外周动静脉换血联合静脉注射丙种球蛋白治疗新生儿溶血症的效果。方法选取2013年1月至2018年5月中国医科大学附属第一医院收治的新生儿溶血症且符合外周动静脉换血指征的患儿70例作为研究对象。应用随机数字表法将其分为外周动静脉换血组、外周动静脉换血+丙种球蛋白组,每组35例。观察两组患儿基线资料、治疗前后血清胆红素变化情况、部分血液生化指标、住院时间和黄疸消退时间。结果外周动静脉换血+丙种球蛋白组患儿治疗后12、24、48、72 h血清胆红素水平[(241.5±48.1)、(184.6±26.3)、(166.3±18.5)、(133.5±20.8)μmol/L]显著低于外周动静脉换血组[(299.3±32.5)、(225.7±38.9)、(195.4±21.1)、(173.8±35.4)μmol/L],差异有统计学意义(P<0.05)。两组患儿治疗后RBC较治疗前[(4.3±0.8)×10^12/L、(4.2±1.0)×10^12/L与(5.2±1.1)×10^12/L、(6.4±1.3)×10^12/L];Hb[(125.8±11.2)g/L、(124.9±10.5)g/L与(148.9±26.5)g/L、(159.3±14.6)g/L]和网织红细胞计数[(7.6±2.1)%、(7.3±1.8)%与(5.2±1.3)%、(3.1±0.5)%]均显著改善,但外周动静脉换血+丙种球蛋白组改善程度显著优于外周动静脉换血组,差异有统计学意义(P均<0.01)。外周动静脉换血+丙种球蛋白组患儿住院时间(10.3±1.9)d和黄疸消退时间(8.6±0.5)d均显著低于外周动静脉换血组(15.5±2.6)d、(10.0±1.1)d,差异有统计学意义(t=9.553、t=6.855,P<0.01)。外周动静脉换血+丙种球蛋白组患儿治疗后发生再次溶血的患儿显著低于外周动静脉换血组[5.7%(2/35)与25.7%(9/35)],差异有统计学意义(χ^2=5.285,P=0.022)。结论外周动静脉换血联合静脉注射丙种球蛋白治疗新生儿溶血症效果较佳,能够显著降低血清胆红素,改善血液生化指标,缩短住院时间和黄疸消退时间,且安全可靠。
Objective To observe the effect of peripheral arteriovenous exchange combined with intravenous gamma globulin in the treatment of neonatal hemolysis.Methods Seventy children with neonatal hemolysis admitted to the first affiliated Hospital of China Medical University from January 2013 to May 2018 and who met the indications for peripheral arteriovenous exchange were selected as the study subjects.The patients were divided into peripheral arteriovenous exchange group and"peripheral arteriovenous exchange+gamma globulin"group by random number table method,with 35 cases in each group.Baseline data of the two groups,changes of serum bilirubin before and after treatment,partial blood biochemical indicators,hospitalization time and jaundice regression time were observed.Results The levels of serum bilirubin((241.5±48.1),(184.6±26.3),(166.3±18.5),(133.5±20.8)μmol/L)in peripheral arteriovenous exchange+gamma globulin group were significantly lower than those in peripheral arteriovenous exchange group((299.3±32.5),(225.7±38.9),(195.4±21.1),(173.8±35.4)μmol/L)at 12,24,48 and 72 hours after treatment,the difference was significant(P<0.05).RBC in children in two groups after treatment was(4.3±0.8)×10^12/L,(4.2±1.0)×10^12/L vs.before(5.2±1.1)×10^12/L,(6.4±1.3)×10^12/L,Hb after treatment in both groups was(125.8±11.2)g/L,(124.9±10.5)g/L vs.before(148.9±26.5)g/L,(159.3±14.6)g/L and reticulocyte count after treatment in both groups were(7.6±2.1)%,(7.3±1.8)%vs.(5.2±1.3)%,(3.1±0.5)%were significantly improved,but the peripheral arteriovenous exchange+gamma globulin group was significantly better than the peripheral arteriovenous transfusion group,the difference was statistically significant(all P<0.05).The hospitalization time(10.3±1.9)d and jaundice regression time(8.6±0.5)d in the peripheral arteriovenous exchange+gamma globulin group were significantly lower than those in the peripheral arteriovenous exchange group((15.5±2.6)d,(10.0±1.1)d).The difference was statistically significant(t=9.553,6.855,P<0.05).The children who had re-hemolytic after treatment in the peripheral arteriovenous exchange+gamma globulin group were significantly lower than the peripheral arteriovenous exchange group(5.7%(2/35)vs.25.7%(9/35)),the difference was statistically significant(χ^2=5.285,P=0.022).Conclusion Peripheral arteriovenous exchange combined with intravenous gamma globulin is effective in the treatment of neonatal hemolysis.It can significantly reduce serum bilirubin,improve blood biochemical parameters,shorten hospitalization time and jaundice regression time,and is safe and reliable.
作者
陈之光
吴红敏
Chen Zhiguang;Wu Hongmin(Department of Neonatrics,the first First Affiliated Hospital of China Medical University,Shenyang 110001,China)
出处
《中国综合临床》
2019年第6期553-557,共5页
Clinical Medicine of China
关键词
新生儿溶血症
外周动静脉换血
丙种球蛋白
疗效
Neonatal hemolysis
Peripheral arteriovenous exchange
Gamma globulin
Therapeutic effect
作者简介
通信作者:吴红敏,Email:chenzhiguang456@163.com。
