本文選題：貧血 + 輸血指征　； 參考：《吉林大學》2012年碩士論文

【摘要】：早產(chǎn)兒貧血是早產(chǎn)兒的常見并發(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，但無癥狀，稱為早產(chǎn)兒生理性貧血，但當早產(chǎn)兒貧血伴隨一定的臨床癥狀時，如皮膚蒼白、淡漠、進食困難、體重不增、呼吸困難、心率增快、活動減少，少數(shù)病例有下肢、足、陰囊及顏面部水腫，此時早產(chǎn)兒貧血則稱為病理性貧血，往往需要干預治療。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、最常見的治療方法，而目前國內(nèi)尚無統(tǒng)一的早產(chǎn)兒輸血指征，多數(shù)都在沿用國外早產(chǎn)兒的輸血指征，且國外就早產(chǎn)兒的輸血指征尚未達成共識，各新生兒中心與中心之間的標準不同，本研究旨在通過觀察我院住院早產(chǎn)兒的輸血情況以期為建立我國早產(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小時內(nèi)首次入住我院NICU病房，體重＜1500g，住院時間≥2周且住院期間接受過輸血治療的早產(chǎn)兒96例為研究對象，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。通過對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、動脈導管再次開放、早產(chǎn)兒視網(wǎng)膜病（retinopathyof prematurity, ROP）的發(fā)生率，真菌感染人數(shù)、死亡人數(shù)，住院天數(shù)等進行記錄，并行統(tǒng)計學分析。計量資料符合正態(tài)分布的用x±s表示，兩組之間的比較采用t檢驗，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，計數(shù)資料兩組之間的比較采用χ2檢驗。 分組后，通過對患兒的基本情況（胎齡、性別、出生體重、入院時基礎Hct）行統(tǒng)計學分析比較得出，觀察1組和觀察2組患兒入院時出生體重、胎齡、性別、入院時HCT差異均無統(tǒng)計學意義，兩組具有可比性，進而對觀察指標進一步分析得出結(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輔助通氣的時間，有利于臨床癥狀的恢復。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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R722.6

【引證文獻】

相關(guān)碩士學位論文 前1條

1 張沂潔;早產(chǎn)兒輸血相關(guān)性移植物抗宿主相關(guān)DNA微衛(wèi)星位點多態(tài)性分析[D];青島大學;2013年

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