Chen Hsiao-Neng, Lee Meng-Luen, Tsao Lon-Yen
Changhua Christian Hospital, Department of Pediatrics, Changhua, Taiwan.
Pediatrics. 2008 Oct;122(4):e905-10. doi: 10.1542/peds.2008-0249. Epub 2008 Sep 8.
The purpose of this study was to compare the efficiency and safety of exchange transfusion by using peripheral arteries and veins with that of conventional exchange transfusion via the umbilical vein in treating neonatal pathologic hyperbilirubinemia.
We retrospectively reviewed the medical charts of all neonates who had undergone exchange transfusion at our institution from January 1995 to December 2006. Causes of jaundice, efficiency of exchange transfusion in lowering serum bilirubin concentrations, adverse events, and outcomes were recorded. Data were compared between neonates who had undergone exchange transfusion via the peripheral arteries and veins method and those who had undergone exchange transfusion via the umbilical vein method. Data were also compared between stable neonates (body weight > 1500 g without medical problems other than jaundice) and unstable neonates.
A total of 123 exchange-transfusion procedures were performed in 102 neonates in the 12-year study period: 24 were performed via the umbilical vein method and 99 via the peripheral vessels method. A total of 87 procedures were performed in 75 stable neonates and 36 in 27 unstable neonates. There was no significant difference in reduction of serum bilirubin level from circulation or the duration of procedures between the 2 methods. Eight neonates died before discharge, but none of the deaths seem to have been attributable to the exchange-transfusion procedure. Severe adverse events occurred more commonly in the umbilical vein group than the peripheral arteries and veins group in the stable neonates. All of the severe and minor events resolved completely without noticeable sequelae before discharge.
Exchange transfusion using peripheral arteries and veins is efficient and effective in reducing serum bilirubin from circulation and is associated with few adverse events. This method should be considered for all neonates requiring exchange transfusion for treatment of neonatal hyperbilirubinemia.
本研究旨在比较采用外周动静脉进行换血治疗与传统经脐静脉换血治疗新生儿病理性高胆红素血症的有效性和安全性。
我们回顾性分析了1995年1月至2006年12月间在本机构接受换血治疗的所有新生儿的病历。记录黄疸病因、换血治疗降低血清胆红素浓度的有效性、不良事件及治疗结果。比较采用外周动静脉换血法与经脐静脉换血法的新生儿的数据。还比较了病情稳定的新生儿（体重>1500g，除黄疸外无其他疾病）和病情不稳定的新生儿的数据。
在12年的研究期间，102例新生儿共接受了123次换血治疗：经脐静脉换血24次，经外周血管换血99次。75例病情稳定的新生儿共接受了87次换血治疗，27例病情不稳定的新生儿接受了36次换血治疗。两种方法在降低循环血清胆红素水平或治疗持续时间方面无显著差异。8例新生儿在出院前死亡，但似乎均与换血治疗无关。在病情稳定的新生儿中，严重不良事件在脐静脉组比外周动静脉组更常见。所有严重和轻微事件在出院前均完全缓解，无明显后遗症。
采用外周动静脉进行换血治疗在降低循环血清胆红素方面有效，且不良事件较少。对于所有需要换血治疗新生儿高胆红素血症的新生儿，均应考虑采用这种方法。
