Therapeutic effect of peripheral arteriovenous exchange combined with intravenous gamma globulin on neonatal hemolysis / 中国综合临床

ABSTRACT

Objective To observe the effect of peripheral arteriovenous exchange combined with intravenous gamma globulin in the treatment of neonatal hemolysis. Methods Seventy children with neonatal hemolysis admitted to the first affiliated Hospital of China Medical University from January 2013 to May 2018 and who met the indications for peripheral arteriovenous exchange were selected as the study subjects. The patients were divided into peripheral arteriovenous exchange group and ＂peripheral arteriovenous exchange+gamma globulin＂ group by random number table method,with 35 cases in each group. Baseline data of the two groups, changes of serum bilirubin before and after treatment, partial blood biochemical indicators, hospitalization time and jaundice regression time were observed. Results The levels of serum bilirubin ((241. 5±48. 1),(184. 6± 26. 3),(166. 3± 18. 5),(133. 5± 20. 8) μmol／L) in peripheral arteriovenous exchange + gamma globulin group were significantly lower than those in peripheral arteriovenous exchange group ((299. 3±32. 5),( 225. 7± 38. 9),(195. 4± 21. 1),( 173. 8± 35. 4) μmol／L) at 12,24,48 and 72 hours after treatment,the difference was significant (P＜0. 05). RBC in children in two groups after treatment was(4. 3±0. 8)×1012／L,(4. 2±1. 0)×1012／L vs. before(5. 2±1. 1)×1012／L,(6. 4±1. 3)×1012／L,Hb after treatment in both groups was (125. 8 ± 11. 2) g／L,( 124. 9 ± 10. 5) g／L vs. before ( 148. 9 ± 26. 5) g／L, (159. 3±14. 6) g／L and reticulocyte count after treatment in both groups were (7. 6±2. 1)%,(7. 3±1. 8)%vs. ( 5. 2 ± 1. 3)%, ( 3. 1 ± 0. 5)% were significantly improved, but the peripheral arteriovenous exchange+gamma globulin group was significantly better than the peripheral arteriovenous transfusion group, the difference was statistically significant ( all P＜0. 05) . The hospitalization time (10. 3±1. 9) d and jaundice regression time ( 8. 6 ± 0. 5) d in the peripheral arteriovenous exchange + gamma globulin group were significantly lower than those in the peripheral arteriovenous exchange group ((15. 5±2. 6) d,(10. 0±1. 1) d) . The difference was statistically significant ( t＝ 9. 553, 6. 855, P＜0. 05) . The children who had re-hemolytic after treatment in the peripheral arteriovenous exchange + gamma globulin group were significantly lower than the peripheral arteriovenous exchange group ( 5. 7%( 2／35) vs. 25. 7%(9／35)),the difference was statistically significant ( χ2 ＝ 5. 285, P ＝ 0. 022 ) . Conclusion Peripheral arteriovenous exchange combined with intravenous gamma globulin is effective in the treatment of neonatal hemolysis. It can significantly reduce serum bilirubin,improve blood biochemical parameters,shorten hospitalization time and jaundice regression time,and is safe and reliable.