A clinical study of the improved treatment of severe neonate hyperbilirubinemia by automatic and synchronous exchange transfusion of peripheral artery and vein / 中国基层医药

ABSTRACT

Objective:To explore the effect and safety of the improved treatment of severe neonate hyperbilirubinemia by the automatic and synchronous exchange transfusion of peripheral artery and vein.Methods:From January 2016 to December 2019, 25 newborns with severe hyperbilirubinemia treated by automatic and synchronous exchange transfusion of peripheral artery and vein were selected in the research.During the operation of exchange transfusion, there were two pathways, the bloodletting one through the arteries and the transfusion one through the veins [the latter was connected to the blood-conveying leather pipeline special for Graseby 3000 syringe pump by the indwelling needle.The filter of the leather pipeline is Y-shaped and had two parallel blood transfusion plugs, one inserted into the red blood cell(RBC) bag, and the other into plasma bag.After infusion of 100 mL of RBC, clamped the RBC bag, and infused 500 mL of plasma.Then clamped the plasma bag and infused 100 mL of RBC.They were alternately operated]. The artery and the vein form a blood circuit, which was controlled by three infusion pumps (the first pump was for bloodletting, the second for transfusion, and the third for heparin sodium infusion). Hence the exchange transfusion became full-automatic.The changes of blood routine, total blood bilirubin(TBIL), blood gas analysis, blood glucose, electrolytes, blood culture and vital signs before and after transfusion were observed.Results:A total of 25 patients were studied, and the exchange transfusion time was controlled between 90-120 minutes.After transfusion, there were no statistically significant changes in breathing, heart rate, blood pressure, electrolytes and blood gas analysis(all P>0.05), while the serum TBIL and platelets(PLT) levels were significantly decreased[the amount of TBIL before and after blood transfusion (485.8±126.5)μmol/L vs.(207.9±68.4)μmol/L; the amount of PLT before and after blood transfusion (301.6±118.3)×10 9/L vs.(125.3±60.2)×10 9/L] ( t=-6.924, P<0.01; t=-7.986, P<0.01), and white the blood cells(WBC) was decreased [before blood transfusion (12.57±6.11)×10 9/L, after blood transfusion (8.98±3.24)×10 9/L, t=-2.922, P<0.05]. The trace blood glucose(TBG) was higher than normal after blood transfusion, with a significant change[before blood transfusion (4.9±0.7)mmol/L, after blood transfusion (7.1±1.5)mmol/L, t=3.866, P<0.01]. TBG restored within 24 h after exchange transfusion, PLT and WBC backed to normal within 72 h. Blood bacterial culture was negative in all cases after the exchange transfusion.No serious complications occurred and all patients were cured. Conclusion:It is simple, safe and reliable to treat severe neonate hyperbilirubinemia by the peripheral automatic exchange transfusion controlled by infusion pumps.The treatment is worthwhile to be recommended for clinical use in primary hospitals.