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目的探讨改良动静脉四泵全自动换血疗法在治疗新生儿重症高胆红素血症中的疗效及安全性。方法选择2011年1月至2014年6月在长治市妇幼保健院新生儿科进行换血治疗的新生儿重症高胆红素血症患儿。治疗时采用一条外周动脉、两条外周静脉进行留置针穿刺,形成换血通道,由四个输液泵(一条动脉为放血通路,两条静脉为输血通路,第四泵为肝素钠输注通路)控制速度,实现全自动换血。结果共纳入研究对象27例,换血平均用时(2.1±0.4)h。换血前、中、后体温、呼吸、心率、收缩压、舒张压、经皮血氧饱和度、p H、PCO2、PO2、BE、钙离子、钾离子、钠离子、氯离子及谷丙转氨酶无显著变化(P>0.05)。换血过程中微量血糖高于正常值,但在换血前、中、后无显著变化(P>0.05)。换血中和换血后血清总胆红素和血小板较换血前显著下降(P<0.05)。换血结束后24 h内微量血糖恢复正常,72 h内血小板恢复正常。结论一动脉两静脉四泵全自动换血疗法在治疗新生儿重症高胆红素血症时疗效可靠,且操作简单、安全,可在基层医院推广使用。
Objective To investigate the efficacy and safety of modified arteriovenous four-pump automatic transfusion therapy in the treatment of neonatal severe hyperbilirubinemia. Methods From January 2011 to June 2014, neonates with severe hyperbilirubinaemia were treated in the Department of Neonatology, Changzhi Municipal Maternal and Child Health Hospital. Treatment with a peripheral artery, the two peripheral venous needle indwelling needle, the formation of transfusion channel, the four infusion pumps (one for the bleeding path, two for the blood transfusion, the fourth pump for the heparin infusion channel) control Speed, to achieve automatic exchange of blood. Results A total of 27 subjects were enrolled in the study. The mean exchange-time was (2.1 ± 0.4) h. Blood transfusion before, during and after the body temperature, respiration, heart rate, systolic blood pressure, diastolic blood pressure, percutaneous oxygen saturation, p H, PCO2, PO2, BE, calcium, potassium, sodium, chloride and alanine aminotransferase Significant changes (P> 0.05). During the blood exchange, the level of trace blood glucose was higher than normal, but there was no significant change before, during and after blood exchange (P> 0.05). After transfusions and transfusions, serum total bilirubin and platelets decreased significantly compared with before transfusions (P <0.05). Micro-blood glucose returned to normal within 24 h after the exchange of blood, platelets returned to normal within 72 h. Conclusions One arterial two-vein four-pump automatic blood transfusion therapy is reliable in the treatment of neonatal severe hyperbilirubinemia with simple and safe operation and can be widely used in primary hospitals.