足月儿换血资料临床回顾

发布时间：2018-06-06 16:05

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

【摘要】：目的探讨新生儿高胆红素血症的病因及危险因素，因换血可能发生的不良反应，以及预后不良的危险因素。方法纳入重庆医科大学附属儿童医院2001年1月至2011年12月间收治的，入院诊断为高胆红素血症并接受换血疗法的足月新生儿609例。记录患儿一般情况、伴随疾病、换血前胆红素峰值水平、换血情况、临床转归等情况。结果患儿的胎龄是39.1±2.6周，黄疸出现时间在35.5±22.6h，入院时年龄84.1±40h，换血前胆红素峰值在455.2117.8μmol/L。其中361例(59.3%)患儿发生ABE，44例(7.2%)患儿预后不良。新生儿高胆红素血症的仍以ABO溶血为主，占60.9%，其次为病因不明(15.8%)，这其中可能有13.5%(13例)的新生儿是因为体重丢失过多而发生高胆红素血症血症。换血相关副反应以血小板减少为主，严重不良反应的发生率为7.2%，以呼吸暂停最为常见，没有患儿因换血而直接死亡。黄疸病因、换血前胆红素峰值、换血时机对患儿的预后有显著影响。结论ABO溶血仍是新生儿严重高胆红素血症最常见的病因，对原因不明的严重黄疸患儿需注意其喂养及体重变化情况，，体重丢失过多可能是其发生高胆红素血症的唯一病因；换血相关的主要不良反应以血液学指标异常为主，且是可治疗的，但仍有可能发生严重不良反应，且黄疸患儿病情越重，发生换血相关严重不良反应的可能性越大。黄疸病因、换血前胆红素峰值、换血时机对患儿的预后有显著影响，对已达到换血标准的高胆红素血症患儿需及时换血。
[Abstract]:Objective to explore the etiology and risk factors of neonatal hyperbilirubinemia, the possible adverse reactions due to exchange transfusion, and the risk factors of poor prognosis.
Methods a total of 609 full-term neonates with hyperbilirubinemia and changing blood therapy were admitted to the Affiliated Children's Hospital of Medical University Of Chongqing from January 2001 to December 2011. The general condition of the children was recorded, with the disease, the peak level of pre exchange bilirubin, the change of blood, and the clinical outcome.
Results the gestational age of the children was 39.1 + 2.6 weeks, the onset time of jaundice was 35.5 + 22.6h, the age was 84.1 + 40H, the peak value of pre exchange bilirubin in 361 cases (59.3%) was ABE, 44 cases (7.2%) had poor prognosis. The neonatal hyperbilirubinemia was still mainly ABO hemolysis, accounting for 60.9%, followed by unknown etiology (15.8%). There may be 13.5% (13 cases) of neonatal hyperbilirubinemia due to excessive loss of weight. Blood transfusion related side effects are mainly thrombocytopenia, and the incidence of severe adverse reactions is 7.2%. The most common adverse reaction is apnea, and no children are dying directly from change of blood. The cause of jaundice, the peak of pre exchange bilirubin and the time of changing blood It has a significant impact on the prognosis of children.
Conclusion ABO hemolysis is still the most common cause of severe hyperbilirubinemia in newborns. Children with unexplained severe jaundice need to pay attention to their feeding and body weight changes. Too much loss of weight may be the only cause of hyperbilirubinemia. The main adverse reaction of blood exchange should be mainly with abnormal hematological indexes and can be treated as a cure. But there is still a serious adverse reaction, and the more serious the illness of the children with jaundice is, the greater the possibility of severe adverse reaction. The cause of jaundice, the peak value of the pre transfusion bilirubin, the timing of the change of blood have a significant influence on the prognosis of the children, and the children who have reached the standard of blood exchange need to change the blood in time.
【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】：R722.17

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