不同输血策略对早产儿的影响

李亚楠; 徐家丽; 彭万胜; 王素梅; 周瑞; 张贝贝

doi:10.13898/j.cnki.issn.1000-2200.2019.07.011

摘要:

目的探讨早产儿限制性输血与非限制性输血策略对早产儿输血情况及一系列临床指标恢复的影响，为早产儿输血策略提供一定的临床依据。

方法根据2008年美国早产儿输血指南，回顾性分析进行输血的胎龄 < 37周的早产儿171例，分为限制性输血组（A组）78例和非限制性输血组（B组）93例，根据胎龄又分为胎龄 < 34周和≥34周，比较2组早产儿在输血总量、输血次数、首次输血日龄、体质量恢复、喂养情况、脱离氧气时间、达出院标准时间、早产儿脑损伤（脑白质软化/颅内出血）发生率等方面的差异。

结果胎龄 < 34周，A组输血次数少于B组（P < 0.01），首次输血日龄、脱氧时间、恢复出生体质量所用时间和脑损伤发生率均为A组高于B组（P < 0.05~P < 0.01）；胎龄≥34周，首次输血日龄和奶量达足量（150 mL/kg）时间A组均高于B组（P < 0.01和P < 0.05）；达完全经口喂养时间和住院时间在胎龄 < 34周和胎龄≥34周早产儿均为A组长于B组（P < 0.05~P < 0.01），输血总量A组与B组差异无统计学意义（P>0.05）。

结论相较于限制性输血，非限制性输血策略不增加输血总量，可能更有利于早产儿的临床恢复，有利于缩短早产儿住院时间、促进喂养及进体质量增长、缩短用氧时间、减少早产儿脑损伤的发生。

Abstract:

ObjectiveTo explore the influences of restrictive and non-restrictive blood transfusion strategies on blood transfusion and clinical indicators of premature infants, and provide a clinical basis for the transfusion strategy of premature infants.

MethodsAccording to the premature infants blood transfusion guidelines of United States in 2008, the clinical data of 171 premature infants with gestational age < 37 weeks were retrospectively analyzed, and divided into the restrictive blood transfusion (group A, 78 cases) and non-restrictive blood transfusion group (group B, 93 cases).According to the gestational age, the premature infants were further divided into the gestational age < 34 weeks group and ≥ 34 weeks group.The differences of the total transfusion, frequency of transfusion, age of first transfusion, body quality recovery, feeding condition, deoxygenation time, time of discharge standard, and incidence rate of brain injury (leuomalacia cerebri/intracranial hemorrhage) between two groups were compared.

ResultsAmong the premature infants with gestational age < 34 weeks, the number of blood transfusion in group A was less than that in group B (P < 0.01), the age of first blood transfusion, deoxygenation time, time to recover birth body quality and incidence rate of brain injury in group A were higher than those in group B (P < 0.05 to P < 0.01).Among the premature infants with gestational age ≥ 34 weeks, the age of first blood transfusion and time of adequate milk volume (150 mL/kg) in group A were higher than those in group B (P < 0.01 and P < 0.05).The time of preterm infants with full oral feeding and hospitalization in group A were longer than those in group B (P < 0.05 to P < 0.01), and the difference of the total amount of blood transfusion was not statistically significant between two groups (P>0.05).

ConclusionsCompared with the restrictive transfusion strategy, the non-restrictive transfusion strategy does not increase of the quantity of blood transfusion, can be more conducive to the clinical recovery of premature infants, shorten the hospitalization time, promote feeding and weight gain, shorten the time of oxygen uptake, and reduce the occurrence of premature infant brain injury.

不同输血策略对早产儿的影响

Effect of different transfusion strategies on premature infants