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目的探讨不同比例成分血对新生儿母子ABO血型不合溶血病(HDN)换血治疗后内环境的影响。方法对2009年1月至2010年4月湖南省儿童医院40例HDN达到换血指征的患儿,采用不同比例成分血行换血术,血源均采用O型浓缩红细胞及AB型血浆。治疗组16例,换血时采用O型浓缩红细胞及AB型血浆的比例为3:1(即O型浓缩红细胞300mL:AB型血浆100mL);对照组24例,采用的比例为2:1。两组换血量均按150～180mL/kg双倍量换血,换血结束后对照组常规输注O型浓缩红细胞15～20mL/kg(总量约60mL),治疗组则不再输血,换血前后其他治疗相同。监测换血前后血清总胆红素、胆红素置换率、血红蛋白、红细胞压积、血清电解质、血气等指标变化。结果两组换血后血清总胆红素均较换血前明显下降,但治疗组下降较对照组更明显,差异有统计学意义(P<0.05)。两组换血前后血红蛋白、红细胞压积比较显示,治疗组换血前后比较差异无统计学意义(P>0.05),对照组比较则差异有统计学意义(P<0.05)。换血后两组血气指标pH、BE值及电解质如K+、Na+、Ca2+、Cl-较换血前差异无统计学意义(P>0.05)。结论采用O型浓缩红细胞及AB型血浆3:1配比的成分血换血治疗HDN,既能迅速降低血清胆红素水平,又能避免贫血的发生,且血清电解质及酸碱平衡在换血前后均无明显差异,值得推广。
Objective To investigate the effects of different proportions of constituent blood on the internal environment of neonatal pregnant women with ABO incompatible hemolytic disease (HDN) transfusion. Methods From January 2009 to April 2010, 40 children with HDN in Hunan Provincial Children’s Hospital were enrolled in this study. Blood transfusions were performed with different proportions of blood components. O-type red blood cells and type AB plasma were used as the source of blood. In the treatment group of 16 cases, the ratio of O-typed erythrocytes and AB-type plasma was 3: 1 (ie, 300mL O-type erythrocytes: 100mL AB plasma). The volume of blood transfusion in both groups was changed by 150 ~ 180mL / kg twice. After the transfusion, the control group received conventional infusion of O-type concentrated red blood cells (15 ~ 20mL / kg) The same as other treatments. Before and after monitoring the exchange of serum total bilirubin, bilirubin replacement rate, hemoglobin, hematocrit, serum electrolytes, blood gas and other indicators change. Results After transfusions, serum total bilirubin was significantly lower than that before transfusions, but the decrease in treatment group was more obvious than that in control group (P <0.05). Hemoglobin and hematocrit before and after transfusion in both groups showed no significant difference before and after transfusion (P> 0.05), while the difference between the two groups was statistically significant (P <0.05). There was no significant difference between the two groups in the change of blood gas pH, BE and electrolyte such as K +, Na +, Ca2 + and Cl- (P> 0.05). Conclusion The treatment of HDN with 3: 1 ratio blood of O type concentrated red blood cells and AB type plasma can not only rapidly reduce the level of serum bilirubin, but also avoid the occurrence of anemia. Serum electrolytes and acid-base balance both before and after blood exchange No significant difference, it is worth promoting.