新生兒交換輸血之臨床及追踪研究

Clinical Observation and Follow-up Studies of Blood Exchange Transfusion in Newborn

呂志忠(Chu-Chong Lu)

《Acta Paediatrica Sinica》 14卷3期 (1973/09) Pp. 92-101

摘要

在高雄醫學院小兒科過去四年多期間，做交換輸血之新生兒例，調查分析其一般臨床狀況及精神體能之生長與發育，並做追踪研究，結果分成：正常健康兒者例，未滿三個月不能判定者例，屬於腦性麻痺羣者例，死亡者例及不明者例。本報告例之追踪研究，其預後近來因選擇條件之改變，有愈好之趨勢，且與母子間血型，血清蛋白質，轉氨基，換血量，時間及速度等換血程序無關係；但與換血兒之黃疸發生日，換血日齡及其間隔，以及血清膽紅素值，膽紅素值昇高速度，臨床症候及病徵，有密切關係。總而言之，著者認爲換血兒之預後，要得到滿意，其主要因素還是黃疸發生後愈早期換血愈好，且要臨床症候及病徵較少，無異常Moro氏反射或感染，同時膽紅素值不太高者爲對象。

並列摘要

Forty four cases of blood exchange transfusion (B. E. T.) were performed at our pediatric department of Kaohsiung Medical College Hospital in recent four years. Analysing the general conditions, mental-somatic growth and development, the results of follow-up studies are divided into: the normal healthy group 15 cases, the group of under three months of age which was difficult to evaluate 6 cases, the group of cerebral palsy 12 cases, the group of death which died during hospitalization 7 cases and the group of unknown outcome 4 cases.
The prognosis of our series was favorable recently since we selected the case strickly. It was not related to the blood type between the mother and the child, the level of serum protein or serum transaminase, volume, time and speed of B. E. T.. However, it was not only dependent on the onset of jaundice, stage of B. E. T. and the interval between the appearance of jaundice and the time of B. E. T., but also serum total bilirubin level, the increasing speed before B. E. T. and clinical symptoms and signs.
For a good prognosis, B. E. T. should be performed as early as possibl if jaundice increased its severity rapidly with fewer clinical symptoms and signs, and absence of abnormal Moro's reflex or infection, especially with low serum biliruhin level.