326例重度高胆红素血症临床分析

发布时间：2018-05-13 19:33

本文选题：重度高胆红素血症 + 预后　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的探讨重度高胆红素血症患儿不良预后的原因及评估方法，为指导治疗及改善预后提供依据。方法搜集2012年1月-12月间在我院新生儿科住院的重度高胆红素血症患儿的病历资料及随访结果进行分析。结果55.56%患儿入院前行胆红素筛查，24小时及72小时内筛查比例4.91%、33.13%。感染性病因（74.40%）及新生儿溶血病（51.19%）为重度高胆红素血症主要病因，胆红素峰值是其不良预后的独立危险因素。溶血组黄疸出现时龄、黄疸持续时间、入院时龄小于无溶血组，B/A值、换血率高于无溶血组。BIND（0-6）分不良预后较轻且有一定可逆性，BIND（7-9）分提示严重不良预后。不良预后组TSB峰值、UCB值、B/A值明显高于无不良预后组，此三者评价不良预后的ROC曲线下面积分别为0.682、0.671、0.698，， TSB=474.5μmol/L，UCB=449.15μmol/L，B/A=0.923mg/g时约登指数最大。有无不良预后组BAEP、NBNA异常率及苍白球信号改变率无统计学差异。有无神经系统异常表现组OAE及BAEP异常率无统计学差异。结论需加强并规范新生儿黄疸监测、随访及诊疗，降低重度极重度高胆红素血症及核黄疸发病率。听力检查结果与神经系统表现不一致，需常规行听力检查。BIND评分表评估不良预后特别是严重不良预后有较好价值。TSB峰值、UCB值、B/A值是不良预后指标。未发现急性期NBNA、听力检查结果及苍白球T1WI高信号与远期预后明确相关，对预后评估的价值需进一步研究。
[Abstract]:Objective to explore the causes and methods of poor prognosis in children with severe hyperbilirubinemia and to provide evidence for guiding treatment and improving prognosis. Methods the medical records and follow-up results of severe hyperbilirubinemia hospitalized in our hospital from January to December 2012 were analyzed. Results the proportion of bilirubin screening within 24 hours and 72 hours before admission was 4.91% and 33.13% respectively. Infection with STDs (74.40) and neonatal hemolysis (51.19) were the main causes of severe hyperbilirubinemia. The peak value of bilirubin was an independent risk factor for poor prognosis. In hemolytic group, the age of jaundice appeared, the duration of jaundice, the age of admission was less than that of no hemolysis group, and the rate of blood exchange was higher than that of non-hemolytic group. The TSB peak value and B / A value of poor prognosis group were significantly higher than that of no poor prognosis group. The area under ROC curve of the three groups was 0.682n 0.671g / g 0.698, and TSB=474.5 渭 mol / L UCBR 449.15 渭 mol 路L ~ (-1) 路L ~ (-1) B ~ (-1) = 0.923 mg 路g ~ (-1) 路g ~ (-1) ~ (-1). There was no significant difference in abnormal rate of BAEPN NBNA and signal change rate of globus pallidus in patients with poor prognosis. There was no significant difference in abnormal OAE and BAEP rates in patients with or without neurological abnormalities. Conclusion it is necessary to strengthen and standardize neonatal jaundice monitoring, follow up, diagnosis and treatment, and reduce the incidence of severe extremely severe hyperbilirubinemia and nuclear jaundice. The results of hearing examination were not consistent with those of nervous system. It was a good value to evaluate the poor prognosis, especially the severe bad prognosis. The UCB value and B / A value of UCB were the indexes of poor prognosis. No significant correlation was found between acute stage Nbna, hearing test results and high signal intensity in globus pallidus (T1WI). The value of NBNA in evaluation of prognosis should be further studied.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.1

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