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Exchange Transfusion

儿科

关键词儿科 治疗方法 黄疸治疗

词汇介绍

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解析

exchange  英 /ɪks'tʃeɪndʒ; eks-/  美 /ɪks'tʃendʒ/

       n. 交换;交流;交易所;兑换

vt. 交换;交易;兑换vi. 交换;交易;兑换

       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/

       n. [临床] 输血;[临床] 输液;倾注;灌输

       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

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

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

影响因子: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.

译文

ET / RET婴儿中ABO不相容的高比例值得关注,因为有几份报告发现这一因素在接受ET和/或RET的婴儿中最为普遍。例如,在一项来自伊朗的研究中,对150名新生儿进行了176次ET治疗,ABO不相容性最常见,其中49.2%的婴儿患有ET,45%的婴儿患有RET。来自土耳其的另一项研究表明,306名接受ET的婴儿中ABO不相容性最常见(27.8%); 8.8%的人要求RET。事实上,ABO不相容性可预测该队列中严重高胆红素血症的婴儿的ET / RET(数据未显示)。尽管我们的研究中恒河猴的不相容性很少,但很少有研究报道这一因素是其人群中患有ET的婴儿中最常见的因素。这强调了人群中遗传和流行病学的异质性,即使在中低收入国家也是如此。在这种情况下,死亡率很少与RET有关,这表明如果及时有效地进行ET,通常是保护性的,但并非没有其他不良事件的风险(4-10)。这项回顾性研究的一些局限性值得注意。首先,与大多数临床图表评论一样,可用信息仅限于在护理点认为必要或可达到的信息。因此,一些相关数据,包括G6PD状态和入院时的体重减轻程度,无法进行分析。其次,一些变量的诊断有效性无法独立评估,尽管我们的分析没有出现虚假结果。第三,很难评估研究期间治疗方案的依从程度,包括光疗持续时间和TSB峰值准确报告的信息。第四,没有提供与ET相关的不良事件或postexchange TSB水平模式的数据。尽管如此,这些关键词与现有文献中的证据是一致的,并且提供了在这种和可比资源约束的环境中削减RET的优先权。