红细胞储存时间对高胆红素血症新生儿换血治疗的疗效及内环境的影响

Effect of red blood cell storage duration on the clinical effect of exchange transfusion and internal environment in neonates with hyperbilirubinemia

摘要:

目的 探讨不同储存时间的红细胞对高胆红素血症新生儿换血治疗的疗效及内环境的影响。方法 回顾性分析2015年1月至2018年8月经换血治疗的135例高胆红素血症新生儿的临床资料，按输入红细胞的储存时间分为短期储存组（储存时间≤ 7 d，n=56）和长期储存组（储存时间 > 7 d，n=79）。比较两组患儿换血后0 h、12 h的血清总胆红素（TBIL）水平与TBIL下降率，以及换血后继续光疗时间及再次换血率。比较分析两组患儿换血前及换血后0 h的血常规、电解质、血糖及血气分析指标的变化。结果 换血后0 h，两组患儿TBIL水平及TBIL下降率比较差异无统计学意义（P > 0.05）；换血后12 h，长期储存组TBIL水平高于短期储存组，TBIL下降率低于短期储存组（P < 0.01）；长期储存组换血后的继续光疗时间更长（P < 0.05）；长期储存组低血钠、高血钾及代谢性酸中毒等换血并发症的发生率较短期储存组增加（P < 0.05）。结论 使用储存时间 > 7 d的红细胞输入不影响新生儿换血治疗的即时效果，但换血后继续光疗效果较差，亦增加了低血钠、高血钾及代谢性酸中毒的发生风险。

Abstract:

Objective To study the effect of red blood cell (RBC) storage duration on the clinical effect of exchange transfusion (ET) and internal environment in neonates with hyperbilirubinemia. Methods A retrospective analysis was performed for the clinical data of 135 neonates with hyperbilirubinemia who received ET between January 2015 and August 2018. According to RBC storage duration, the neonates were divided into short-term storage group (RBCs were stored for ≤ 7 days) with 56 neonates and long-term storage group (RBCs were stored for > 7 days) with 79 neonates. The two groups were compared in terms of serum total bilirubin (TBIL) level and the rate of TBIL reduction at 0 and 12 hours after ET, as well as the duration of continued phototherapy and rate of repeated ET. Routine blood test parameters, electrolytes, blood glucose, and blood gas parameters were measured before ET and at 0 hour after ET. Results At 0 hour after ET, there were no significant differences in the TBIL level and the rate of TBIL reduction between the two groups (P > 0.05). At 12 hours after ET, the long-term storage group had a significantly higher TBIL level and a significantly lower rate of TBIL reduction than the short-term storage group (P < 0.01). The long-term storage group had a significantly longer duration of continued phototherapy after ET than the short-term storage group (P < 0.05). Compared with the short-term storage group, the long-term storage group had significantly higher incidence rates of ET-related complications, including hyponatremia, hyperkalemia, and metabolic acidosis (P < 0.05). Conclusions The use of RBCs with a storage duration of > 7 days in ET for neonates with hyperbilirubinemia does not affect the immediate effect of ET, but these neonates tend to have a poor outcome after continued phototherapy and high risk of hyponatremia, hyperkalemia, and metabolic acidosis.