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, possible adverse reactions due to exchange of blood, and risk factors for poor prognosis. Methods the patients were admitted to the Children's Hospital affiliated to Chongqing Medical University from January 2001 to December 2011. 609 term neonates who were diagnosed as hyperbilirubinemia and received exchange therapy were admitted to hospital. Results the gestational age was 39.1 卤2.6 weeks, the onset time of jaundice was 35.5 卤22.6 h, the age of admission was 84.1 卤40 h, and the peak of bilirubin before exchange was 455.2117.8 渭 mol / L. The prognosis was poor in 361 cases (59.3%). ABO hemolysis was the main cause of neonatal hyperbilirubinemia, accounting for 60.9%, followed by 15.8 cases of unknown etiology, of which 13 cases may have hyperbilirubinemia due to excessive weight loss. Thrombocytopenia was the main side effect of hemodialysis, and the incidence of serious side effects was 7.2. Apnea was the most common, and no children died directly as a result of exchange of blood. Conclusion ABO hemolysis is still the most common cause of severe hyperbilirubinemia in neonates. Children with severe jaundice with unknown causes should pay attention to their feeding and weight change. Excessive weight loss may be the only cause of hyperbilirubinemia. It is treatable, but it is still possible to produce serious adverse reactions, and the more serious the condition of children with jaundice, the more likely it is to have serious adverse reactions related to blood exchange. The causes of jaundice, the peak value of bilirubin before blood exchange, the timing of blood exchange had significant influence on the prognosis of children, and the patients with hyperbilirubinemia who had reached the standard of exchange of blood needed to exchange 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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