Analysis of the effect and influencing factors of red blood cell infusion in very low birth weight infants
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摘要: 目的 研究影响极低出生体重儿(VLBWI)红细胞输注疗效的因素，提高临床VLBWI输血疗效。方法 选取医院新生儿重症监护室2020年1月1日—2021年12月31日，输注去白细胞悬浮红细胞的VLBWI患儿258例作为研究对象。根据VLBWI的胎龄、出生体重、输血有效性进行分组，回顾性分析不同胎龄、体重VLBWI输血效果及影响VLBWI输血疗效的因素。分析输血后24 h血红蛋白(Hb)上升值与临床指标的相关性，比较输血前后代谢指标和电解质指标的差异。结果 VLBWI输血后Hb、红细胞比容(HCT)显著升高，升高均值分别为(37.31±17.32) g/L、(10.56±5.60)%；VLBWI胎龄越小、体重越轻，其输血前Hb越高、输血次数越多、住院时间越长；输血有效组和输血无效组比较，其中胎龄、出生体重、输血次数、输血间隔时间、输血量差异有统计学意义(P＜0.05)，而Apgar评分、红细胞储存时间差异无统计学意义(P>0.05)；输血后24 h Hb上升值与胎龄、出生体重、输血量呈正相关(P＜0.05)，与输血前Hb值呈负相关(P＜0.05)，与Apgar评分、红细胞储存时间无相关性(P>0.05)；VLBWI输血后24 h总胆红素显著高于输血前(P＜0.05)，而输血前、输血后24 h酸碱度、乳酸的差异无统计学意义(P>0.05)；患儿输血后24 h血钠、血钾显著高于输血前(P＜0.05)。结论 胎龄、出生体重、输血量影响VLBWI输血疗效，红细胞储存时间与输血疗效无相关性，VLBWI输血后应密切关注总胆红素、血钠、血钾的变化。Abstract: Objective To study the factors affecting the efficacy of red blood cell transfusion in very low birth weight infants(VLBWI) and improve the efficacy of clinical VLBWI transfusion.Methods From January 1, 2020 to December 31, 2021, 258 VLBWI children who were transfused with leukocyte-free suspended red blood cells in neonatal intensive care unit were selected as the study objects. According to the gestational age, birth weight and transfusion effectiveness of VLBWI, the effects of different gestational age and weight VLBWI transfusion and the factors affecting the efficacy of VLBWI transfusion were retrospectively analyzed. The correlation between hemoglobin(Hb) rise value and clinical indexes at 24 h after transfusion was analyzed, and the differences of metabolic indexes and electrolyte indexes before and after transfusion were compared.Results Hb/HCT increased significantly after VLBWI transfusion, and the mean increases were(37.31±17.32) g/L and(10.56±5.60)%, respectively. The smaller the gestational age and the lighter the weight of VLBWI, the higher the Hb before transfusion, the more the number of transfusion and the longer the hospital stay. There were significant differences in gestational age, birth weight, blood transfusion times, blood transfusion interval and blood transfusion volume between effective and ineffective transfusion groups(P<0.05), but no significant differences in Apgar score and red blood cell storage time(P>0.05). Hb rise value at 24 h after transfusion was positively correlated with gestational age, birth weight and transfusion volume(P<0.05), but negatively correlated with Hb value before transfusion(P<0.05), and had no correlation with Apgar score and red blood cell storage time(P>0.05). Total bilirubin at 24 h after VLBWI transfusion was significantly higher than that before transfusion(P<0.05), but there was no significant difference in pH and lactic acid between before transfusion and 24 h after transfusion(P>0.05). Blood sodium and potassium at 24 h after transfusion were significantly higher than those before transfusion(P<0.05).Conclusion Gestational age, birth weight and blood transfusion volume could affect the efficacy of VLBWI transfusion. Red blood cell storage time might have no correlation with the efficacy of transfusion. The changes of total bilirubin, blood sodium and blood potassium should be paid close attention to after VLBWI transfusion.
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表 1 VLBWI患儿总体输血疗效指标比较
X±S 疗效指标 例数 输血前 输血后24 h t P Hb/(g/L) 258 101.49±11.71 138.79±17.87 -59.232 ＜0.001 HCT/% 258 30.36±3.65 40.92±5.65 -51.465 ＜0.001 
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表 2 不同胎龄VLBWI患儿输血疗效比较
X±S 胎龄/周 例数(%) 输血次数/次 住院天数/d 输血量/mL 输血前Hb/(g/L) 输血后24 h Hb/(g/L) 输血7 d后Hb/(g/L) ＜28 44(17.1) 5.51±3.46 71.44±30.88 19.46±6.01 109.23±11.43 138.25±18.01 116.93±13.00 28~29 106(41.1) 3.28±1.63 59.94±15.52 23.55±6.52 107.92±10.81 143.71±17.73 122.19±14.61 30~35 108(42.0) 2.25±1.28 48.57±14.62 28.03±7.08 103.24±11.23 144.62±18.15 125.25±16.78 F 38.825 22.018 28.877 7.544 2.082 2.067 P ＜0.001 ＜0.001 ＜0.001 0.001 0.127 0.130
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表 3 不同出生体重VLBWI患儿输血疗效比较
X±S 出生体重/g 例数(%) 输血次数/次 住院天数/d 输血量/mL 输血前Hb/(g/L) 输血后24 h Hb/(g/L) 输血7 d后Hb/(g/L) ＜1 000 37(14.3) 5.50±3.32 71.53±28.06 15.92±4.13 110.81±11.13 138.71±19.02 116.93±13.00 1 000~1 200 85(32.9) 3.78±2.17 62.62±22.60 22.41±5.53 106.15±11.12 141.53±16.12 122.19±14.61 1 210~1 500 136(52.7) 2.23±1.07 49.43±11.52 28.61±6.29 105.02±11.42 145.37±18.56 125.25±16.78 F 44.716 23.340 79.563 3.831 2.436 2.067 P ＜0.001 ＜0.001 ＜0.001 ＜0.050 0.090 0.130
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表 4 影响VLBWI患儿输血疗效的相关因素分析
X±S 指标 输血无效组(n=44) 输血有效组(n=214) t P 胎龄/周 29.40±1.84 28.29±2.02 -3.533 ＜0.050 男/女/例 22/22 106/108 0.013 0.910 出生体重/kg 1.219±0.185 1.118±0.221 -2.800 ＜0.050 输血量/mL 30.04±9.70 24.1±8.95 -5.955 ＜0.050 储存时间/d 17.50±6.56 17.24±6.94 -0.373 0.709 1 min Apgar评分/分 7.64±1.48 7.44±1.50 -0.781 0.436 5 min Apgar评分/分 8.76±1.04 8.55±1.03 -1.097 0.274 输血前Hb/(g/L) 100.13±11.04 110.12±12.43 8.631 ＜0.050 输血后24 h Hb/(g/L) 141.63±17.05 121.81±13.12 -13.953 ＜0.050 输血次数/次 2.97±2.00 4.38±3.02 2.703 ＜0.050 输血间隔时间/d 12.84±8.03 8.96±7.60 -3.905 ＜0.050 TBIL上升值/(μmol/L) 9.46±26.04 13.01±25.86 -0.645 0.520
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表 5 影响VLBWI患儿输血疗效的疾病因素分析
例(%) 指标 输血无效组(n=44) 输血有效组(n=214) t P 新生儿肺炎 41(93.18) 195(91.12) 0.031 0.861 呼吸窘迫综合征 37(84.09) 194(90.65) 2.633 0.105 支气管肺发育不良 32(72.73) 149(69.63) 0.079 0.779 败血症 13(29.55) 62(28.97) 0.001 0.983 房/室间隔缺损 7(15.91) 56(26.17) 2.212 0.137 凝血功能异常 14(31.82) 48(22.43) 1.627 0.202 坏死性小肠结肠炎 10(22.73) 49(22.90) 0.005 0.943 新生儿高胆红素血症 6(13.64) 36(16.82) 0.310 0.577 早产儿视网膜病变 10(22.73) 17(7.94) 8.277 ＜0.050
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表 6 VLBWI患儿输血后24 hHb上升值与输血临床指标相关性分析
指标 相关性参数 胎龄 出生体重 1 min Apgar评分 5 min Apgar评分 输血量 储存时间 输血前Hb值 Hb上升值 r 0.189 0.202 0.057 0.039 0.203 0.023 -0.324 P ＜0.05 ＜0.05 0.384 0.562 ＜0.05 0.717 ＜0.05
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表 7 VLBWI患儿输血前后安全性指标比较
X±S 安全性指标 输血前 输血后 t P TBIL/(μmol/L) 84.26±51.49 92.40±56.93 -4.756 ＜0.050 pH值 7.37±0.08 7.37±0.08 0.062 0.951 LAC/(mmol/L) 1.43±1.10 1.37±0.84 1.158 0.247 Na+/(mmol/L) 137.02±4.50 137.79±4.53 -4.390 ＜0.050 K+/(mmol/L) 3.67±0.66 3.74±0.72 -2.029 ＜0.050
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