儿科
词汇介绍
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解析
exchange 英 /ɪks'tʃeɪndʒ; eks-/ 美 /ɪks'tʃendʒ/
释 义 n. 交换；交流；交易所；兑换
vt. 交换；交易；兑换vi. 交换；交易；兑换
例 句 But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas. 如果你有一个思想，我有一个思想，彼此交换，我们每个人都有两个思想，甚至多于两个思想。
transfusion 英 /træns'fjuːʒ(ə)n; trɑːns-; -nz-/ 美 /trænz'fjʊʒən/
释 义 n. [临床] 输血；[临床] 输液；倾注；灌输
例 句 They might not hemolyze spontaneously in the bottle, but they did not survive after transfusion. 红细胞可能没有自然地使溶解在瓶里，但红细胞在输血后不会生存。
概述
概述
新生儿病理性黄疸是新生儿常见疾病部分，患儿病情严重可并发急性胆红素脑（ABE），甚至遗留核黄疸等严重后遗症。换血疗法可迅速降低患儿血清胆红素水平，是重症高胆红素血症最有效的治疗措施。
指征
（1）患儿在准备换血的同时先予以光疗4-6 h，若血清总胆红素（TSB）水平未下降或持续上升，或免疫性溶血患儿在光疗后TSB水平下降幅度未达到34-50 mmol/L（2~3 mg/dl），立即予以换血。（2）严重溶血，出生时脐血胆红素＞76 mmol/L（4.5 mg/dl），血红蛋白＜110 g/L，伴有水肿、肝脾大和心力衰竭。（3）已有 ABE临床表现患儿无论TSB水平是否达到上述换 血标准，均予以换血。在上述标准的基础上，TSB与白蛋白（B/A）比值作为换血决策的参考，如胎龄≥38周新生儿B/A值达8.0，胎龄≥38周伴溶血或胎龄35-37周新生儿B/A值达7.2，胎龄35-37周伴溶血新生儿B/A值达6.8，作为考虑换血的附加依据。
方法
（1）血源选择：Rh溶血病选择Rh血型同母亲，ABO血型同患儿，紧急情况下选择O型血。（2）换血量：为新生儿血容量的2倍（150-160 ml/kg）。（3）换血途径：可选择脐静脉或其他较粗的外周静脉，也可选择脐动脉或外周动脉、外周静脉同步换血。
不良反应
换血后7 d内发生任何一种并发症定义为换血相关不良反应；程度相对较重，延长住院时间，甚至危及生命的事件定义为换血相关严重不良反应，包括呼吸暂停、呼吸衰竭、心力衰竭、坏死性小肠结肠炎（NEC）、弥散性血管内凝血（DIC）、心动过缓（心率＜80次/min）、血压波动导致颅内出血、休克、应激性溃疡，呼吸心跳骤停等。
Predictors of Repeat Exchange Transfusion for Severe Neonatal Hyperbilirubinemia
复制标题
重复换血治疗重症新生儿高胆红素血症的预测因素
发表时间：2016-03-10
影响指数：2.8
作者： Cecilia A Mabogunje
期刊：Pediatr Crit Care Med
The high proportion of ABO incompatibility among infants with ET/RET deserves attention based on several reports that found this factor as the most prevalent among infants who received ET and/or RET. For example, in one study from Iran in which 176 ETs were administered to 150 neonates, ABO incompatibility was the commonest, reported in 49.2% of the infants who had ET and 45% of the 20 infants with RET . Another study from Turkey showed that ABO incompatibility was the most common (27.8%) in the 306 infants who received ET; 8.8% of whom required RET. In fact, ABO incompatibility was predictive of ET/RET among infants with severe hyperbilirubinemia in this cohort (data not shown). Although Rhesus incompatibility was rare in our study, few studies have reported this factor as the most common among infants who had ET in their populations. This underscores the heterogeneity in the genetic and epidemiologic prole across populations, even in LMICs. Mortality was rarely associated with RET in this setting, suggesting that ET is generally protective if done promptly and effectively but not without the risk of other adverse events (4–10).A few limitations of this retrospective study are worth noting. First, like most clinical chart reviews, the available information was limited to what was considered necessary or attainable at the point of care. As a result, some relevant data, including the G6PD status and degree of weight loss at admission, were not available for analysis. Second, the diagnostic validity of some of the variables could not be independently evaluated, although no spurious results emerged from our analyses. Third, it was dif cult to evaluate the degree of compliance with the treatment protocol over the study period, including information on the duration of phototherapy and accurate reporting of peak TSB. Fourth, no data on adverse events associated with ET or the pattern of postexchange TSB levels were provided. Notwithstanding, the keyndings are consistent with evidence in the existing literature and provide priorities for curtailing RET in this and comparable resource-constrained settings.
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