关键词: 黄疸, 换血疗法, 内环境, 影响, 新生儿

Abstract: Objective To summarize the changes of relevant parameters before and after exchange transfusion, and to provide basis for clinical application.Methods Newborns with complete clinical data who underwent exchange transfusion therapy because of jaundice, hospitalized in neonatal ward from 1996 to 2013, were enrolled as the research subjects. A retrospective analysis of clinical data was performed using paired t-test and χ² test. Results From 1996 to 2013, 111 cases were treated with exchange transfusion in the neonatal ward, data of 85 cases treated with exchange transfusion were collected and analyzed. In this 85 cases treated with exchange transfusion, 81 cases (95.3%) had hemolytic disease, including 71 cases (87.7%) of Rh incompatibility, 9 cases (11.1%) of ABO incompatibility, one case (1.2%) of Rh and ABO hemolytic disease; one case (1.2%) had glucose-6-phosphate dehydrogenase (G6PD) deficiency and 3 cases (3.5%) had unknown hyperbilirubinemia. Exchange transfusion removed 48.0% of total body bilirubin, 47.8% of unconjugated bilirubin. After exchange transfusion, the total serum bilirubin, indirect bilirubin, direct bilirubin and albumin ratio (B/A) was decreased as compared with those of pre-exchange levels, the difference was statistically significant. The red blood cell counts and hemoglobin increased, the difference was statistically significant. Analysis of the one-hour-bilirubin, all of the hour-bilirubin was located in P95 region (100%) before exchange transfusion, which is high risk of bilirubin encephalopathy. After the exchange transfusion, 33 cases (38.8%) located in low risk area, 22 cases (25.9%) in low intermediate risk, 16 cases (18.8%) in high intermediate risk area, and 14 cases (16.5%) still located in P95 region. It suggested that the exchange transfusion can effectively decrease the risk of bilirubin encephalopathy. In this study, 77 cases (90.6%) developed adverse events after exchange transfusion. Among them, the most common adverse event was hyperglycemia in 61 cases (79.2%), hypocalcemia in 46 cases (59.7%), hypokalemia in 33 cases (42.9%), thrombocytopenia in 28 cases (36.4%), and metabolic acidosis in 15 cases (19.5%). Conclusion Exchange transfusion show definite effect in treatment of neonatal jaundice. It can reduce the risk of bilirubin encephalopathy and hemolytic reaction at the same time, and can correct anemia. Exchange transfusion changes the environment of blood. After the exchange transfusion, there is a high incidence of adverse reactions, the indications should be strictly controlled and the parameters should be carefully monitored.

Key words: jaundice, exchange transfusion, internal environment, influence, newborn