本文選題：貧血 + 輸血指征��； 參考：《吉林大學(xué)》2012年碩士論文

【摘要】：早產(chǎn)兒貧血是早產(chǎn)兒的常見(jiàn)并發(fā)癥之一，分為生理性貧血和病理性貧血，部分早產(chǎn)兒雖有貧血，但無(wú)癥狀，稱為早產(chǎn)兒生理性貧血，但當(dāng)早產(chǎn)兒貧血伴隨一定的臨床癥狀時(shí)，如皮膚蒼白、淡漠、進(jìn)食困難、體重不增、呼吸困難、心率增快、活動(dòng)減少，少數(shù)病例有下肢、足、陰囊及顏面部水腫，此時(shí)早產(chǎn)兒貧血?jiǎng)t稱為病理性貧血，往往需要干預(yù)治療。早產(chǎn)兒貧血的防治包括減少醫(yī)源性失血、藥物治療及輸血治療，其中輸血治療是其中最有效、最常見(jiàn)的治療方法，而目前國(guó)內(nèi)尚無(wú)統(tǒng)一的早產(chǎn)兒輸血指征，多數(shù)都在沿用國(guó)外早產(chǎn)兒的輸血指征，且國(guó)外就早產(chǎn)兒的輸血指征尚未達(dá)成共識(shí)，各新生兒中心與中心之間的標(biāo)準(zhǔn)不同，本研究旨在通過(guò)觀察我院住院早產(chǎn)兒的輸血情況以期為建立我國(guó)早產(chǎn)兒合理的輸血指征提供一定的臨床依據(jù)。 本文選用2010年10月1日至2011年10月1日之間出生，生后24小時(shí)內(nèi)首次入住我院NICU病房，體重＜1500g，住院時(shí)間≥2周且住院期間接受過(guò)輸血治療的早產(chǎn)兒96例為研究對(duì)象，根據(jù)患兒輸血前Hct數(shù)值分為觀察1組54例，觀察2組42例。通過(guò)對(duì)上述患兒的輸血情況，包括輸血前血紅蛋白值、每次輸血量、總的輸血量、輸血次數(shù)，以及吸氧、同步間歇指令通氣（synchronized intermittent mandatory ventilation, SIMV）、持續(xù)正壓通氣（continuous positive airway pressure, CPAP）時(shí)間及人數(shù)、呼吸暫停發(fā)作人數(shù)和發(fā)作天數(shù)、氨茶堿的使用人數(shù)以及使用天數(shù)、發(fā)生顱內(nèi)出血、腦白質(zhì)軟化的比例、動(dòng)脈導(dǎo)管再次開(kāi)放、早產(chǎn)兒視網(wǎng)膜�。╮etinopathyof prematurity, ROP）的發(fā)生率，真菌感染人數(shù)、死亡人數(shù)，住院天數(shù)等進(jìn)行記錄，并行統(tǒng)計(jì)學(xué)分析。計(jì)量資料符合正態(tài)分布的用x±s表示，兩組之間的比較采用t檢驗(yàn)，不符合正態(tài)分布的用M(P25，，P75)表示，兩組之間的比較采用秩和檢驗(yàn)，計(jì)數(shù)資料兩組之間的比較采用χ2檢驗(yàn)。 分組后，通過(guò)對(duì)患兒的基本情況（胎齡、性別、出生體重、入院時(shí)基礎(chǔ)Hct）行統(tǒng)計(jì)學(xué)分析比較得出，觀察1組和觀察2組患兒入院時(shí)出生體重、胎齡、性別、入院時(shí)HCT差異均無(wú)統(tǒng)計(jì)學(xué)意義，兩組具有可比性，進(jìn)而對(duì)觀察指標(biāo)進(jìn)一步分析得出結(jié)論：1.限制性輸血可增加極低出生體重兒總的輸血量及輸血次數(shù)。2.非限制性輸血可減少極低出生體重兒的呼吸機(jī)輔助通氣的時(shí)間，有利于臨床癥狀的恢復(fù)。3.非限制性輸血可能減少極低出生體重兒顱內(nèi)出血的發(fā)生，降低真菌感染率及死亡率。
[Abstract]:Anemia in premature infants is one of the common complications of premature infants, which is divided into physiological anemia and pathological anemia. Although some premature infants have anemia, they are asymptomatic, so they are called physiological anemia of preterm infants, but when anemia of preterm infants is accompanied by certain clinical symptoms,If the skin is pale, indifferent, eating difficulty, weight gain, dyspnea, heart rate increase, activity decrease, a few cases have lower limbs, feet, scrotum and facial edema, this time premature anemia is called pathological anemia,Intervention is often required.The prevention and treatment of anemia in premature infants include reducing iatrogenic blood loss, drug therapy and blood transfusion treatment. Among them, blood transfusion therapy is the most effective and most common treatment method. At present, there is no uniform indication of blood transfusion for preterm infants in China.Most of them are following the indications of blood transfusion for premature infants abroad, and there is no consensus on the blood transfusion indications of premature infants abroad. The standards of each neonatal center and center are different.The purpose of this study was to provide a clinical basis for the establishment of reasonable blood transfusion indications for premature infants in China by observing the blood transfusion status of premature infants in our hospital.96 premature infants born between October 1, 2010 and October 1, 2011, who were first admitted to the NICU ward within 24 hours after birth, weighing less than 1500g, staying in hospital for more than 2 weeks and receiving blood transfusion treatment during hospitalization, were selected as the study subjects.According to the Hct values before blood transfusion, 54 cases were divided into observation group (n = 54) and observation group (n = 42).According to the blood transfusion condition of the above children, including the value of hemoglobin before transfusion, the volume of each transfusion, the total amount of blood transfusion, the number of times of blood transfusion, the time and number of oxygen inhalation, synchronized intermittent mandatory ventilation, continuous positive pressure ventilation, continuous positive airway pressure, and the number of CPAPs.The number and duration of apnea, the number and duration of aminophylline use, the incidence of intracranial hemorrhage, the proportion of leukomalacia, the re-opening of ductus arteriosus, the incidence of retinopathy of preterm infants (ROP), the number of fungal infections,The number of deaths and the days of hospitalization were recorded, and the statistical analysis was carried out.The measured data were expressed by x 鹵s, the comparison between the two groups was expressed by t test, the comparison between the two groups was expressed by MNP P25 / P75), the comparison between the two groups was expressed by rank sum test, and the comparison between the two groups was analyzed by 蠂 2 test.After grouping, the basic conditions (gestational age, sex, birth weight, basic HCT at admission) were analyzed and compared. The birth weight, gestational age, sex at admission were observed in group 1 and group 2.There was no significant difference in HCT between the two groups at admission, and the two groups were comparable.Restricted blood transfusion can increase the total transfusion volume and blood transfusion times of very low birth weight infants.Non-restrictive blood transfusion can reduce the time of ventilator-assisted ventilation in very low birth weight infants and is beneficial to the recovery of clinical symptoms. 3.Non-restrictive blood transfusion may reduce the incidence of intracranial hemorrhage, fungal infection and mortality in very low birth weight infants.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R722.6

【引證文獻(xiàn)】

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