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目的 探讨高胆红素血症新生儿换血前后血液内环境变化。方法 58例次均采用双管同步抽注法,其中32例脐静脉-周围静脉,26例桡动脉-周围静脉。除ABO溶血病采用O型洗涤红细胞+AB型血浆外,其余采用与患儿同型的ACD血。平均换血量159.58ml/kg,平均换血速度74.33ml/(kg·h)。换血前后抽血送检胆红素、血气、血常规、电解质、血糖及肾功能,计数资料用t检验对比分析。结果血清胆红素换出率48.21%,换血前后血pH及红细胞压积(HcT)、Na+、Cl-、尿素氮(BUN)、血肌酐(Cr)无差异性(P>0.05),换血后Hb、白细胞(WBC)、血小板(PLT)分别下降10.03%、31.40%、47.69%。血游离钙(iCa)、k+、Mg2+明显降低(P<0.01、P<0.01、P<0.05),血糖明显升高(P<0.01)。结论换血对血细胞、血糖及电解质影响较大。换血后应注意感染、贫血及出血发生,避免输注高渗糖,补充钾及钙剂,不能忽视低镁。
Objective To investigate the change of blood environment in neonates with hyperbilirubinemia before and after blood transfusion. Fifty-eight patients were treated by double-pipe simultaneous pumping, including 32 cases of umbilical vein-peripheral vein and 26 cases of radial artery-peripheral vein. In addition to ABO hemolytic disease using O-type red blood cells + AB-type plasma, the other with the same type of children with ACD blood. The average exchange rate of 159.58ml / kg, the average exchange rate of 74.33ml / (kg · h). Before and after blood transfusion bilirubin, blood gas, blood, electrolyte, blood glucose and renal function, counting data using t test comparative analysis. Results Serum bilirubin exchange rate was 48.21%. There was no difference in blood pH and hematocrit (HcT), Na +, Cl-, BUN and Cr before and after transfusion (P> 0.05) Hb, WBC and PLT decreased 10.03%, 31.40% and 47.69% respectively. Blood calcium (iCa), k +, Mg2 + were significantly lower (P <0.01, P <0.01, P <0.05), blood glucose was significantly higher (P <0.01). Conclusion Blood transfusion has a great influence on blood cells, blood glucose and electrolytes. After the exchange of blood should pay attention to infection, anemia and bleeding, to avoid infusion of hypertonic sugar, potassium and calcium supplement, can not ignore the low magnesium.