CAJ | 학술논문

目的：探讨需机械通气的极危重症高胆红素血症足月新生儿实施换血治疗的条件、安全性及疗效。方法2010年1月至2013年3月新生儿科10例需机械通气的极危重症高胆红素血症足月新生儿，经常规生命支持治疗基本生命体征趋平稳后，进行外周动静脉换血术，监测并比较换血前后的胆红素、血小板、血钙、凝血功能及血气等指标，观察机械通气条件下换血的效果以及不良反应发生情况。结果研究过程中无死亡病例，胆红素的总换出率达50.5%，不良反应以血小板低下最明显（80%），换血前后血小板计数差异有统计学意义（P<0.05），血钙离子、pH值、碳酸氢根离子、凝血酶原时间、活化部分凝血活酶时间在换血前后的差异均无统计学意义（P均<0.05）。结论需机械通气治疗的极危重高胆红素血症新生儿，经常规生命支持治疗使基本生命体征趋向平稳后进行紧急的换血治疗仍是相对安全的，胆红素的换出效果较理想，且严重不良反应的发生率较少，但远期神经系统预后情况仍需进一步观察。
목적：탐토수궤계통기적겁위중증고담홍소혈증족월신생인실시환혈치료적조건、안전성급료효。방법2010년1월지2013년3월신생인과10례수궤계통기적겁위중증고담홍소혈증족월신생인，경상규생명지지치료기본생명체정추평은후，진행외주동정맥환혈술，감측병비교환혈전후적담홍소、혈소판、혈개、응혈공능급혈기등지표，관찰궤계통기조건하환혈적효과이급불량반응발생정황。결과연구과정중무사망병례，담홍소적총환출솔체50.5%，불량반응이혈소판저하최명현（80%），환혈전후혈소판계수차이유통계학의의（P<0.05），혈개리자、pH치、탄산경근리자、응혈매원시간、활화부분응혈활매시간재환혈전후적차이균무통계학의의（P균<0.05）。결론수궤계통기치료적겁위중고담홍소혈증신생인，경상규생명지지치료사기본생명체정추향평은후진행긴급적환혈치료잉시상대안전적，담홍소적환출효과교이상，차엄중불량반응적발생솔교소，단원기신경계통예후정황잉수진일보관찰。
Objective To explore the conditions, safety and efifcacy of exchange transfusion for extremely severe hyper-bilirubinemia in term newborns requiring mechanical ventilation. Methods Ten full-term newborns of extremely severe hyper-bilirubinemia requiring mechanical ventilation were selected from January 2010 to March 2013 in the department of neonatology. After stable vital sign was achieved by the use of conventional life support, peripheral arterial and venous synchronous exchange transfusion was performed. The bilirubin, platelets, blood calcium, blood coagulation and blood gas were monitored before and after exchange transfusion. The effects and adverse events of exchange transfusion in newborns on mechanical ventilation were observed. Results There was no death in the study, and the replacement rate of total bilirubin was 50.5%. The main adverse event was thrombocytopenia (80%). There was a signiifcant difference in platelet counting before and after exchange transfusion (P<0.05). There was no signiifcant difference in blood coagulation, pH/HCO3-of the blood gas, prothrombin time (PT) and acti-vated partial thromboplastin time (APTT) before and after exchange transfusion. Conclusions It is relatively safe to implement an exchange transfusion in the full-term newborns with severe hyperbilirubinemia in newborns requiring mechanical ventilation, but the use of conventional life support is prerequisite because it stabilizes vital signs. The relatively ideal replacement rate of bili-rubin and the low incidence of adverse reactions are expected. However long-term prognosis of neural system is still unknown.