Application And Efficacy Analysis Of Peripheral Arteriovenous Synchronous Exchange In Neonatal ABO Hemolysis

Objective:By comparing the changes of indirect serum bilirubin level and internal environment index before and after exchange transfusion in neonates with ABO hemolysis,the curative effect and influence of exchange transfusion were evaluated.Methods:A retrospective analysis was made on 242 newborns with ABO hemolysis who reached the exchange needle from January 2013 to October 2014 in our hospital.That is to say,(1)at the birth of full-term infants,Hb<120 g/L in umbilical cord blood,bilirubin>85.5 umol/L(5 mg/dL)in umbilical cord blood,accompanied by edema,hepatosplenomegaly and heart failure.(2)The capillary Hb<120 g/L and decreased progressively 24 hours after birth,Serum bilirubin>257 umol/L(15mg/dL)within24 hours after birth,Serum bilirubin>342 umol/L(20mg/dL)within 48 hours,Serum bilirubin was higher than 428 umol/L(25mg/dL)72 hours later.(3)Early symptoms of nuclear jaundice.According to whether the parents sign and agree to exchange blood treatment,They were divided into two groups.126 cases in the treatment group(routine treatment+exchange of blood),The treatment group received synchronous exchange of peripheral arteries and veins.116 cases in the control group received only routine treatment(blue light+probiotics).The exchange group was half an hour before the exchange of blood(T1)and half an hour after the exchange of blood(T2)at two time points,while the control group was one day after the exchange of blood and two time points after routine treatment.Peripheral venous blood was collected.Serum indirect bilirubin,platelet and blood sugar were measured.Results:Compared with T1,The level of serum indirect bilirubin(IBil)in the treatment group and the control group decreased at T2.The difference was significant(P<0.05).The serum indirect bilirubin in the exchange group decreased from(390.048±39.058)umol/L,before the exchange to(194.010±41.065)umol/L after the exchange.The indirect bilirubin in the control group decreased from(383.452±42.820)umol/L,before treatment to(292.014±39.998)umol/L,after treatment.The decrease of serum indirect bilirubin in the treatment group was more obvious than that in the control group.The difference was significant(P<0.05).Compared with T1,The platelet(PLT)and blood sugar(BS)in the treatment group decreased at T2.The platelets decreased from(350.66±32.564)~∧109/L before blood exchange to(91.37±24.766)~∧109/L after blood exchange.The difference was significant(P<0.05).The blood sugar decreased from(5.490±0.876)mmol/L before blood exchange to(2.965±0.593)mmol/L after blood exchange.The difference was significant(P<0.05).Three days after the general exchange of blood,Re-examination of blood routine and biochemical indicators in children.Platelets and blood sugar returned to normal by themselves.There were no neurological complications.The discharge time was not prolonged.Conclusion:Exchange therapy can significantly reduce bilirubin levels in neonates with ABO hemolysis.Reduce the incidence of bilirubin encephalopathy.Exchange therapy has certain influence on the internal environment of neonates with ABO hemolysis.It is easy to cause thrombocytopenia.Blood sugar decreased.But the change of internal environment is reversible.In this study,all children recovered to normal by themselves.No complications occurred.