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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (02) : 166 -170. doi: 10.3877/cma.j.issn.1673-5250.2021.02.007

所属专题： 文献；

论著

不同输血策略治疗早产儿贫血疗效分析
李君1,1, 陈茂琼2,†,2(), 王榜珍2,2, 陈晓霞2,2   
  • 收稿日期:2020-01-03 修回日期:2021-03-04 出版日期:2021-04-01
  • 通信作者: 陈茂琼

Curative effect analysis of different transfusion strategies for anemia of premature infants

Jun Li1,1, Maoqiong Chen2,2,†(), Bangzhen Wang2,2, Xiaoxia Chen2,2   

  • Received:2020-01-03 Revised:2021-03-04 Published:2021-04-01
  • Corresponding author: Maoqiong Chen
  • Supported by:
    Science and Technology Foundation of Guizhou Provincial Health Commission(gzwjkj2020-1-143)
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李君, 陈茂琼, 王榜珍, 陈晓霞. 不同输血策略治疗早产儿贫血疗效分析[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(02): 166-170.

Jun Li, Maoqiong Chen, Bangzhen Wang, Xiaoxia Chen. Curative effect analysis of different transfusion strategies for anemia of premature infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(02): 166-170.

目的

探讨限制性输血(RBT)和非限制性输血(LBT)对早产儿贫血的疗效。

方法

选择2015年1月至2017年12月，于贵州医科大学附属医院诊断为早产儿贫血，并接受红细胞输注(RBCT)治疗的264例早产儿为研究对象。回顾性分析其临床病例资料。根据采用的RBCT策略，将其分为RBT组(n＝147)和LBT组(n＝117)。对2组早产儿的一般临床资料、输血治疗及住院情况，以及输血相关疾病发生率等，采用独立样本t检验、χ2检验及Wilcoxon秩和检验进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①RBT组早产儿累计接受RBCT量及次数，输血后血红蛋白(Hb)与血细胞比容(HCT)升高幅度，以及机械通气、胃肠外营养及住院时间分别为90.0 mL(70.0～120.0 mL)、2次(2～2次)、(63.0±21.2) g/L、(17.5±6.2)%、10 d(3～18 d)、16 d(9～22 d)及31.0 d(23.0～38.0 d)，均多于、高于、长于LBT组的80.0 mL(62.5～110.0 mL)、2次(1～2次)、(51.9±23.2) g/L、(13.8±7.1)%、0(0～3 d)、6 d (2～14 d)及17.0 d(9.5～26.5 d)，并且差异均有统计学意义(Z＝—2.134、P＝0.033；Z＝—3.588、t＝4.053、t＝4.532、Z＝—8.925、Z＝—6.714、Z＝—7.351，均为P<0.001)。②RBT组早产儿输血后肝功能损害、支气管肺发育不良(BPD)发生率分别为25.2%(37/147)、29.3%(43/147)，均高于LBT组的18.8%(22/117)、3.4%(4/117)，并且差异均有统计学意义(χ2＝6.931、P＝0.008，χ2＝30.785、P＝0.001)。2组早产儿输血后红细胞增多症、肾功能损害、医院感染(NI)、新生儿坏死性小肠结肠炎(NEC)、脑室内出血(IVH)及早产儿视网膜病(ROP)发生率比较，差异均无统计学意义(P>0.05)。

结论

对早产儿贫血采取LBT策略的疗效优于RBT。

关键词: 红细胞输注, 贫血, 限制性输血, 非限制性输血, 治疗结果, 婴儿, 早产
Objective

To explore the therapeutic effect of restrictive transfusion (RBT) and liberal transfusion (LBT) in the treatment of premature infants with anemia.

Methods

From January 2015 to December 2017, a total of 264 premature infants who were diagnosed as anemia in Affiliated Hospital of Guizhou Medical University and received red blood cell transfusion (RBCT) treatment were selected as research subjects. Clinical data of them were analyzed retrospectively.According to RBCT strategies, they were divided into RBT group (n=147) and LBT group (n=117). The general clinical data, transfusion and hospitalization conditions, and incidence of blood transfusion-related diseases between two groups were statistically analyzed by independent-samples t test, chi-square test and Wilcoxon rank sum test. This study met requirements of World Medical Association Declaration of Helsinki revised in 2013.

Results

①Total volumes and times of RBCT, increasing levels of hemoglobin (Hb) and hematocrit (HCT) after transfusion, and duration of mechanical ventilation, parenteral nutrition time and hospitalization of premature infants in RBT group were 90.0 mL (70.0-120.0 mL), 2 times (2-2 times), (63.0±21.2) g/L, (17.5±6.2)%, 10 d (3-18 d), 16 d (9-22 d) and 31.0 d (23.0-38.0 d), respectively, which were significantly more, higher and longer than those of 80.0 mL(62.5-110.0 mL), 2 times (1-2 times), (51.9±23.2) g/L, (13.8±7.1)%, 0 d (0- 3 d), 6 d (2-14 d) and 17.0 d (9.5-26.5 d), respectively in LBT group, and all differences were statistically significant (Z=—2.134, P=0.033; Z=—3.588, t=4.053, t=4.532, Z=—8.925, Z=—6.714, Z=—7.351, all P<0.001). ② Incidences of liver function damage and bronchopulmonary dysplasia (BPD) of premature infants in RBT group after transfusion were 25.2%(37/147) and 29.3%(43/147), respectively, which were significantly higher than those of 18.8%(22/117) and 3.4%(4/117), respectively in LBT group, and all differences were statistically significant (χ2=6.931, P=0.008; χ2=30.785, P=0.001). There were no significant differences between two groups of premature infants after transfusion in incidences of polycythemia, renal function injury, nosocomial infection (NI), neonatal necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) (P>0.05).

Conclusion

Therapeutic effect of LBT is better than RBT for treatment of anemia in premature infants.

Key words: Erythrocyte transfusion, Anemia, Restrictive transfusion, Liberal transfusion, Treatment outcome, Infant, premature
表1 2组早产儿一般临床资料比较
组别 例数 出生体重(g，±s) 胎龄(周，±s) 男性早产儿[例数(%)] 剖宫产娩出[例数(%)] 单胎儿[例数(%)] 生后1 min Apgar评分[分，M(P25～P75)] 5 min Apgar评分[分，M(P25～P75)]
RBT组 147 1 863±383 32.7±2.1 95(64.6) 79(53.7) 98(66.7) 8(6～9) 9(9～10)
LBT组 117 1 951±479 33.4±2.2 66(56.4) 66(56.4) 81(69.2) 8(5～9) 9(8～10)
检验值   t＝—6.437 t＝—6.532 χ2＝1.848 χ2＝0.189 χ2＝0.196 Z＝—0.199 Z＝—0.089
P值   0.063 0.058 0.174 0.673 0.658 0.843 0.929
表2 2组早产儿输血治疗及住院情况比较
组别 例数 RBCT总量[mL，M(P25～P75)] RBCT总次数[次，M(P25～P75)] 输血后Hb升高幅度(g/L, ±s) 输血后HCT升高幅度(%，±s) 机械通气时间[d，M(P25～P75)] 胃肠外营养时间[d，M(P25～P75)] 住院时间[d，M(P25～P75)]
RBT组 147 90.0(70.0～120.0) 2(2～2) 63.0±21.2 17.5±6.2 10(3～18) 16(9～22) 31.0(23.0～38.0)
LBT组 117 80.0(62.5～110.0) 2(1～2) 51.9±23.2 13.8±7.1 0(0～3) 6(2～14) 17.0(9.5～26.5)
检验值   Z＝—2.134 Z＝—3.588 t＝4.053 t＝4.532 Z＝—8.925 Z＝—6.714 Z＝—7.351
P值   0.033 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
表3 2组早产儿输血相关疾病发生率比较[例数(%)]
组别 例数 红细胞增多症 肝功能损害 肾功能损害 NI NEC BPD IVH ROP
RBT组 147 0(0) 37(25.2) 5(3.4) 19(12.9) 11(7.5) 43(29.3) 8(5.4) 2(1.4)
LBT组 117 1(0.9) 22(18.8) 4(3.4) 14(12.0) 7(6.0) 4(3.4) 3(2.6) 0(0)
χ2值   —a 6.931 0.000b 0.055 0.231 30.785 0.727b —a
P值   0.443 0.008 1.000 0.815 0.631 0.001 0.394 0.505
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