Abstract: Objective　To investigate the effect and safety of the treatment for severe hyperbilirubinemia in neonates by plasma exchange. Methods　Aretrospective study was conducted. The newborns who received plasma exchange or peripheral arteriovenous synchronous exchange transfusion for extremely severe neonatal hyperbilirubinemia in the Pediatric Intersive Care Unit of the Children’s Hospital Affiliated to Xi’an Jiaotong University from January 2019 to December 2020 were enrolled as the research subjects. The general demographic data were collected and the changes in serum-related indexes before and after treatment and the changes in mean arterial pressure during treatment were recorded. Social and economic factors of the two treatments were compared. Results　Plasma exchange was performed in 18 cases and a total of 36 children who were treated by peripheral arteriovenous synchronous exchange transfusion were matched by propensity score. There was no statistically significant difference in baseline data between the two groups（P＞0.05）. The mean value of total bilirubin（TBil） and indirect bilirubin（IBil） was significantly reduced by both treatments；plasma exchange therapy［ TBil（μmol/L）：571.21±113.31 vs．235.82±66.71，IBil（μmol/L）：529.06±107.85 vs．218.92±6.36，P＜0.05］；peripheral arteriovenous synchronous exchange transfusion［ TBil（μmol/L）：567.15±99.18  vs．294.34±96.17，IBil（μmol/L）：536.25±87.79 vs．288.54±46.73，P＜0.05］；the bilirubin clearance ratio of plasma exchange was higher than that of peripheral arteriovenous synchronous exchange transfusion，and the differnece was statistically significant（P＜0.05）. The utilization rate of albumin，intravenous immunoglobulin，albumin combined with intravenous immunoglobulin，the amount of plasma used，the amount of red blood cell suspension used，the duration of blue light treatment，and the hospital stay time for single disease were all lower in plasma exchange group than in the peripheral arteriovenous synchronous exchange transfusion group，the differences being statistically significant（all P＜0.05）. Conclusion　Plasma exchange can achieve rapid，effective and safe removal of bilirubin on the basis of maintaining the stability of the internal environment of the body，reducing the transfustion of blood products，and saving social resources. It may be an effective clinical technique in pediatric intensive care unit.

Key words: plasma exchange, hyperbilirubinemia, neonatal, peripheral arteriovenous synchronous exchange transfusion, propensity score matching

摘要： 目的　探讨血浆置换在新生儿高胆红素血症（极重度）治疗中的有效性及安全性。方法　采用回顾性分析研究方法，选择2019年1月至2020年12月西安交通大学附属儿童医院重症医学科因新生儿高胆红素血症（极重度）行血浆置换或动静脉同步换血治疗的患儿为研究对象，收集患儿的人口学资料及治疗前后的血清相关指标变化及治疗过程中平均动脉压变化差异，并对两种治疗社会经济学因素进行比较。结果　血浆置换患儿18例，采用倾向性评分匹配同期应用外周动静脉同步换血治疗患儿36例。 两组基线资料差异均无统计学意义（均P＞0.05）；两种治疗方式使总胆红素（TBil）及间接胆红素（IBil）均值明显下降，血浆置换治疗［TBil（μmol/L）：571.21±113.31 vs．235.82±66.71，IBil（μmol/L）：529.06±107.85 vs．218.92±6.36，P＜0.05］；外周动静脉同步换血治疗［TBil（μmol/L）：567.15±99.18  vs．294.34±96.17，IBil（μmol/L）：536.25±87.79 vs．288.54±46.73，P＜0.05］，血浆置换胆红素清除率比外周动静脉同步换血治疗更高，差异均有统计学意义（均P＜0.05）；血浆置换组治疗在白蛋白、静脉免疫球蛋白、白蛋白联合静脉免疫球蛋白等使用率以及血浆使用量、红细胞悬液使用量、蓝光治疗时间、单病种住院时间等方面均低于外周动静脉同步换血组，差异均具有统计学意义（均P＜0.05）。结论　血浆置换能在维持机体内环境稳定基础上达到快速、有效、安全地清除胆红素，减少血制品的输注，节约社会资源，可能成为儿童重症医学科一项有效的临床技术。 

关键词: 血浆置换, 高胆红素血症, 新生儿, 外周动静脉同步换血, 倾向性评分匹配