新生儿重症高胆红素血症换血疗法的相关问题

发布时间：2018-10-17 13:24

【摘要】：目的通过对重症高胆红素胆红素值、临床表现、治疗手段及短期预后进行分析，了解本中心有无过度换血的现象。方法收集本中心2011年1月~2012年12月达到换血标准但未进行换血疗法的重症高胆红素血症新生儿的临床资料，根据基线控制的方法，选择各时段性别、胎龄、总胆红素值、胆红素/白蛋白比值等主要特点与未换血患儿无统计学差异的接受换血治疗患儿，组成换血组，对两组入院情况、诊疗过程及预后进行回顾性分析。结果共纳入270例，换血组与未换血组各135例，每组根据入院时龄分为：24小时组，24~48小时组，48~72小时组，72时组。四时段性别比例、胎龄、阴道分娩比例、出生体重、入院体重、体质量丢失,换血组与未换血组比较，均无统计学差异（P0.05）。全部换血组、未换血组血清总胆红素分别为（411.38±70.38）μmol/L，（412.78±69.68）μmol/L，两组无统计学差异（t=0.16，P=0.87）。72小时时段，换血组BIND评分（1.77±2.12）高于未换血组（1.07±1.28），差异有统计学意义（t=2.46，P=0.02）。本研究中，ABO溶血病（55.6%）是新生儿重症高胆红素血症最主要的原因，其次为血管外溶血（7.0%）。换血组的新生儿溶血病84例，31例（36.9%）输注静脉丙种球蛋白，其中换血前使用者5例（5.9%）。未换血组新生儿溶血病73例，55例（75.3%）输注静脉丙种球蛋白。两组BAEP异常率（χ2=1.17，P=0.28）和NBNA评分异常率（χ2=1.97，P=0.16）无统计学差异。换血组完善头颅MRI15人，异常者9人，未换血组完善MRI检查5人，3例异常。129/135发生换血相关不良反应，大部分是血液生化指标异常，严重不良反应发生率仅为5.2%（7/135）。24小时、48~72小时、72小时三时龄段换血组住院时间均值均大于未换血组住院时间，其中72小时组差异有统计学意义（t=3.84,P0.001）。结论换血疗法是高风险的侵入性治疗，在对重症高胆红素血症患者选择干预方案时不能过于依赖国内外制订的胆红素参考值，，尤其当患儿时龄大于72时，要综合考虑病因、临床表现、一般情况等；对无明显胆红素脑损伤表现的新生儿溶血病患儿可尝试高强度光疗联合静脉免疫球蛋白输注，降低换血的频率。
[Abstract]:Objective to analyze the hyperbilirubin value, clinical manifestations, treatment methods and short-term prognosis of severe hyperbilirubin. Methods the clinical data of severe hyperbilirubinemia neonates with severe hyperbilirubinemia who met the exchange standard from January 2011 to December 2012 were collected. According to the baseline control method, the sex and gestational age of each period were selected. The main characteristics of total bilirubin, bilirubin / albumin ratio were not significantly different from those of children without hemodialysis. The two groups were divided into two groups. The admission, diagnosis and treatment process and prognosis of the two groups were analyzed retrospectively. Results 270 cases were included, 135 cases in each group. According to the age of admission, each group was divided into four groups: 24 hours group, 24 hours group, 48 hours group, 72 hours group. The sex ratio, gestational age, vaginal delivery ratio, birth weight, admission weight, body mass loss, and no significant difference were found between the two groups (P0.05). The serum total bilirubin was (411.38 卤70.38) 渭 mol/L, (412.78 卤69.68) 渭 mol/L, in all and no exchange group (412.78 卤69.68) 渭 mol/L, respectively (t = 0.16, P < 0. 87). At 72 hours, the BIND score in the exchange group (1. 77 卤2. 12) was higher than that in the control group (1. 07 卤1. 28), and the difference was statistically significant (t = 2. 46, P < 0. 02). In this study, ABO hemolytic disease (55.6%) was the most important cause of severe hyperbilirubinemia, followed by extravascular hemolysis (7.0%). Among 84 cases of neonatal hemolytic disease, 31 cases (36.9%) were infused with intravenous immunoglobulin (IVG), among which 5 cases (5.9%) were users before exchange of blood. Among 73 cases of hemolytic disease of newborns, 55 cases (75.3%) were infused with intravenous immunoglobulin. There was no significant difference between the two groups in the abnormal rate of BAEP (蠂 2 + 1.17) and the abnormal rate of NBNA score (蠂 2 1. 97 P 0. 16). There were 9 cases of abnormal head MRI15 in the exchange group, 5 cases of perfect MRI examination in the non-exchange group, 3 cases were abnormal. 129R / 135 related adverse reactions occurred, most of them were abnormal in blood biochemical index. The incidence rate of severe adverse reactions was only 5.2% (7 / 135). The mean hospitalization time of 24 hours, 48 minutes 72 hours, 72 hours at 03:00 was higher than that of non-exchange group, and the difference of 72 hours group was statistically significant (t = 3.84, P 0.001). Conclusion Exchange therapy is a high risk invasive therapy. When choosing intervention regimen for patients with severe hyperbilirubinemia, we should not rely too much on the reference value of bilirubin made at home and abroad, especially when the age of children is more than 72. It is necessary to consider the etiology, clinical manifestation, general situation and so on. The high intensity phototherapy combined with intravenous immunoglobulin infusion can be used to reduce the frequency of hemolysis in neonates without obvious bilirubin brain injury.
【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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