切换至 "中华医学电子期刊资源库"

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)
引用本文:

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/OL]. 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/OL]. 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。

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.

表1 2组早产儿一般临床资料比较
表2 2组早产儿输血治疗及住院情况比较
表3 2组早产儿输血相关疾病发生率比较[例数(%)]
[1]
Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a Meta-analysis of observational data[J]. Pediatrics, 2012, 129(3):529-540. DOI: 10.1542/peds.2011-2872.
[2]
Baer VL, Lambert DK, Henry E, et al. Red blood cell transfusion of preterm neonates with a Grade 1 intraventricular hemorrhage is associated with extension to a Grade 3 or 4 hemorrhage[J]. Transfusion, 2011, 51(9):1933-1939. DOI: 10.1111/j.1537-2995.2011.03081.x.
[3]
Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants[J]. Sci Rep, 2014, 4:4340. DOI: 10.1038/srep04340.
[4]
Brooks SE, Marcus DM, Gillis D, et al. The effect of blood transfusion protocol on retinopathy of prematurity: a prospective, randomized study[J]. Pediatrics, 1999, 104(3 Pt 1):514-518. DOI: 10.1542/peds.104.3.514.
[5]
邵肖梅,叶鸿瑁,丘小汕. 实用新生儿学[M]. 4版. 北京:人民卫生出版社,2011: 597.
[6]
Strauss RG. How I transfuse red blood cells and platelets to infants with the anemia and thrombocytopenia of prematurity[J]. Transfusion, 2008, 48(2):209-217. DOI: 10.1111/j.1537-2995.2007.01592.x.
[7]
中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志,2001, 81(5):314-320. DOI: 10.3760/j:issn:0376-2491.2001.05.027.
[8]
徐春彩,朱佳骏,朱以琳,等. 极低出生体质量儿输血相关危险因素分析[J]. 临床儿科杂志,2017, 35(9):641-644. DOI: 10.3969/j.issn.1000-3606.2017.09.001.
[9]
姚文静,徐巍,严超英. 早产儿贫血临床输血指征的探讨[J]. 中华血液学杂志,2012, 33(7):561-565. DOI: 10.3760/cma.j.issn.0253-2727.2012.07.019.
[10]
沈晓霞,杜立中,施丽萍,等. 不同输血策略对贫血的极低出生体重儿治疗转归的影响[J]. 中国当代儿科杂志,2010, 12(1):9-12.
[11]
Venâncio JP, Santos AM, Guinsburg R, et al. Strict guideline reduces the need for RBC transfusions in premature infants[J]. J Trop Pediatr, 2007, 53(2):78-82. DOI: 10.1093/tropej/fml062.
[12]
Whyte R, Kirpalani H. Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants[J]. Cochrane Database Syst Rev, 2011, (11):CD000512. DOI: 10.1002/14651858.CD000512.pub2.
[13]
Kasat K, Hendricks-Muñoz KD, Mally PV. Neonatal red blood cell transfusions: searching for better guidelines[J]. Blood Transfus, 2011, 9(1):86-94. DOI: 10.2450/2010.0031-10.
[14]
Bell EF, Strauss RG, Widness JA, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants[J]. Pediatrics, 2005, 115(6):1685-1691. DOI: 10.1542/peds.2004-1884.
[15]
王宝宏,吴玉梅,王克煊,等. 限制性输血与非限制性输血对贫血极低出生体重早产儿病情预后的影响[J]. 中国医师杂志,2013, 15(12):1666-1669. DOI: 10.3760/cma.j.issn.1008-1372.2013.12.022.
[16]
Ghavam S, Batra D, Mercer J, et al. Effects of placental transfusion in extremely low birthweight infants: Meta-analysis of long- and short-term outcomes[J]. Transfusion, 2014, 54(4): 1192-1198. DOI: 10.1111/trf.12469.
[17]
Elremaly W, Mohamed I, Mialet-Marty T, et al. Ascorbylperoxide from parenteral nutrition induces an increase of redox potential of glutathione and loss of alveoli in newborn guinea pig lungs[J]. Redox Biol, 2014, 2: 725-731. DOI: 10.1016/j.redox.2014.05.002.
[18]
Chen HL, Tseng HI, Lu CC, et al. Effect of blood transfusions on the outcome of very low body weight preterm infants under two different transfusion criteria[J]. Pediatr Neonatol, 2009, 50(3):110-116. DOI: 10.1016/S1875-9572(09)60045-0.
[1] 费一鸣, 刘卓, 张丽娟. 组学分析在早产分子机制中的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 504-510.
[2] 黄蓉, 梁自毓, 祁文瑾. NLRP3炎症小体在胎膜早破孕妇血清中的表达及其意义[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 540-548.
[3] 谢江燕, 王亚菲, 贺芳. 妊娠合并血栓性血小板减少性紫癜2例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 556-563.
[4] 韩肖燕, 杨桦. 中孕期孕妇血清胎盘生长因子水平低与胎儿不良预后的关系[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 398-402.
[5] 徐婷婷, 詹泳池, 王晓东, 刘兴会. 电子胎心监测结果出现正弦波形的胎母输血综合征围生期结局分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 382-389.
[6] 梅娟, 陶旭炜. 弥散性血管内凝血为首发表现先天性肝内门体静脉分流新生儿2例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 322-330.
[7] 朴成林, 蓝炘, 司振铎, 李强, 冯健, 安峰铎, 冷建军. 胰十二指肠切除联合肝切除术疗效分析:附5例报告(附视频)[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 363-367.
[8] 郑伟军, 郑超, 方一凡, 吴典明, 王翔, 陈飞, 刘明坤. 新生儿急性阑尾炎17例诊治分析并文献回顾[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 291-293.
[9] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[10] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
[11] 张龙, 孙善柯, 徐伟, 李文柱, 李俊达, 池涌泉, 何广胜, 成峰, 王学浩, 饶建华. 腹腔镜脾切除治疗血液系统疾病的临床疗效分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 870-875.
[12] 雷永琪, 刘新阳, 杨黎渝, 铁学宏, 俞星新, 耿志达, 刘雨, 陈政良, 惠鹏, 梁英健. 肝脏血管周上皮样细胞肿瘤合并贫血一例并文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 710-718.
[13] 王贝贝, 崔振义, 王静, 王晗妍, 吕红芝, 李秀婷. 老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 355-362.
[14] 李茂军, 唐彬秩, 吴青, 阳倩, 梁小明, 邹福兰, 黄蓉, 陈昌辉. 新生儿呼吸窘迫综合征的管理:多国指南/共识及RDS-NExT workshop 共识陈述简介和评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 607-617.
[15] 刘昌恩, 李岩, 张其德. 基于内镜筛查发现的自身免疫性胃炎的临床特征分析[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(04): 233-237.
阅读次数
全文


摘要