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目的探讨不同疾病对高危高胆红素血症患儿在换血过程中胆红素、血常规、凝血功能等变化的影响,从而为安全使用最新黄疸换血指南提供借鉴和帮助。方法收集该院2010-2014年33例使用成分血换血疗法治疗高危高胆红素血症患儿的临床资料,包括基本情况、黄疸原因疾病谱、换血过程中血常规、生化指标等;将患儿按照原发疾病分为溶血组、红细胞葡萄糖-6-磷酸脱氢酶(G-6-PD)缺乏组、G-6-PD缺乏合并感染组、其他组,分析疾病对换血过程中内环境、胆红素、凝血功能及后遗症的影响。结果在新指南下的换血病例中,新生儿溶血病溶血13例。按黄疸原因进行分组,4组总胆红素在换血过程中变化趋势相同(F=2.103,P=0.126),均呈下降趋势;疾病对换血内环境、凝血功能影响不明显,但是换血后各组血钾、血小板及白细胞下降,血钙升高。4组患儿血浆凝血酶原时间(PT)(F=1.528,P=0.216)、活化部分凝血活酶时间(APTT)(F=0.347,P=0.792)差异无统计学意义,且在换血前后PT(F=2.830,P=0.098),APTT(F=0.347,P=0.792)差异均无统计学意义;而纤维蛋白原(FIB)在组间(F=2.838,P=0.045)、换血前后(F=10.346,P=0.002)差异均有统计学意义,换血后FIB降低。结论疾病因素并不影响换血总胆红素下降效果,但是仍需要及时对病因进行诊断,同时在换血过程中需要监测生化指标、凝血功能等的变化,及时对症处理。
Objective To investigate the effect of different diseases on the changes of bilirubin, blood routine and coagulation function in high risk patients with hyperbilirubinemia during transfusions, so as to provide reference and help for the safe use of the latest jaundice transfusion guidelines. Methods The clinical data of 33 children with high risk of hyperbilirubinemia using the blood component exchange transfusion therapy during the period from 2010 to 2014 in our hospital were collected, including the basic information, disease spectrum of jaundice, blood routine and blood biochemical indexes during transfusion, Children were divided into hemolytic group, G-6-PD deficient group, G-6-PD lacked combined infection group, and other groups according to the primary disease. , Bilirubin, coagulation and sequelae effects. Results in the new guidelines under the transfusion cases, hemolytic hemolysis in 13 cases. According to the causes of jaundice, the change trend of total bilirubin in 4 groups was the same (F = 2.103, P = 0.126), which showed a decreasing trend. The disease had no obvious effect on the internal environment of blood transfusion and coagulation function, Group potassium, thrombocytopenia and leukopenia, elevated serum calcium. There was no significant difference in the prothrombin time (PT) between the 4 groups (F = 1.528, P = 0.216) and APTT (F = 0.347, P = 0.792) (F = 2.830, P = 0.098), and APTT (F = 0.347, P = 0.792). There was no significant difference in FIB between the two groups (F = 2.838, P = 0.045) (F = 10.346, P = 0.002), the difference was statistically significant, FIB after transfusion decreased. Conclusion The disease factors do not affect the blood transfusion of total bilirubin decline, but still need timely diagnosis of the cause, at the same time in the process of blood transfusion need to monitor changes in biochemical indicators, coagulation, and timely symptomatic treatment.