注册本刊作者作者投稿查稿
专家远程审稿编辑在线审稿
编务办公专区主编办公专区
下载文档
工作动态
联系方式
发行周期:
月刊
主管单位:
上海市卫生健康委员会
主办单位:
上海市医学会
编辑出版:
《上海医学》编辑部
联系地址:
上海市北京西路1623号
邮编:
200040
电话:
021-62178606
传真:
021-62178606
邮箱:
smasmj@shsma.org.cn
ISSN:
ISSN0253-9934
CN:
CN31-1366/R
收款账号:
1001255309008900719
账户名:
上海市医学会
开户行:
工商银行上海市静安寺支行
友情链接

当前位置：首页 >

同族免疫性溶血高胆红素血症新生儿换血选择中的一个两难决定
The choice of exchange transfusion when the decline degree is within 34 μmol /L below exchange threshold after 6 hours extensive phototherapy

浏览(1654) 下载(0)

DOI:
作者:
包涵，陈豪，龚小慧，裘刚，魏东
Han Bao,Hao Chen,Xiaohui Gong,Gang Qiu,Dong Wei
作者单位:
上海市儿童医院，上海交通大学附属儿童医院新生儿科
Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University
关键词:
高胆红素血症,新生儿；换血治疗；核黄疸
Hyperbilirubinemia, neonatal; Exchange transfusion, whole blood; Kernicterus
摘要:
目的：探讨孕周35周以上无急性胆红素脑病同族免疫性溶血高胆红素血症新生儿强光疗6小时后血胆红素水平降至换血阈值下幅度小于34 μmol/L时的换血选择。方法：回顾性分析2015年1月1日-2018年10月31日本院孕周35周以上同族免疫性溶血高胆红素血症新生儿病例251例。最后符合标准纳入研究60例，分为换血组28例和非换血组32例，统计黄疸消退时间，头颅磁共振（Magnetic Resonance Imaging，MRI）、脑干听觉诱发电位（Brainstem Auditory Evoked Potential, BAEP）、新生儿神经行为评分（Neonatal Behavioral Neurological Assessment ，NBNA）异常比例，核黄疸确诊、可能、疑似病例比例，输血或血制品不良反应比例。结果：换血组黄疸消退时间明显短于非换血组（P＜0.05）。换血组住院期间首次BAEP异常比例低于非换血组（P=0.092）但无统计学意义。头颅MRI异常、NBNA异常、 BAEP复查异常和输血或血制品不良反应比例两组间无差异（P＞0.05）。3月后(＜4月)两组均无核黄疸确诊和可能病例，核黄疸疑似病例比例换血组低于非换血组但无统计学意义（P=0.079）。核黄疸疑似病例中换血组BAEP异常和MRI异常各1例，均为住院期间首次BAEP或MRI异常者；非换血组MRI异常3例，BAEP异常2例，MRI和BAEP同时异常2例，均为住院期间首次BAEP或MRI异常者；两组均未发现住院期间首次BAEP或MRI正常而3月后(＜4月)复查异常的病例。非换血组住院期间首次BAEP异常者大多（8/12）在3月(＜4月)后恢复正常。结论：孕周35周以上无急性胆红素脑病同族免疫性溶血高胆红素血症新生儿换血准备过程中强光疗6小时后血胆红素水平降至换血阈值下幅度低于 34umol /L ，换血尽管可以缩短黄疸消退时间，但并不能明确其对减轻听力损害和神经异常有确切作用，换血宜谨慎。
Objective: To explore the choice of exchange transfusion(ET) in isoimmune hemolytic hyperbilirubinemia(IHH) newborns（gestational age≥35weeks） without acute bilirubin encephalopathy(ABE) when total serum bilirubin (TSB) level declines below the exchange transfusion threshold(ETT) but the decline degree is within 34 μmol /L after 6 hours extensive phototherapy. Methods：Retrospectively analyzed medical records of 251 newborns (gestatinal age ≥ 35 weeks) with IHH admitted to The department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University from jan,2015 to oct,2018. Finally 60 cases meeting the criteria were enrolled and divided into ET group (28 cases) and non ET group( 32 cases). Jaundice remission time; ratio of cases with abnormal head Magnetic Resonance Imaging (MRI), Brainstem Auditory Evoked Potential (BAEP) , Neonatal Behavioral Neurological Assessment (NBNA ); ratio of cases with certain, probable, possible kernicterus; ratio of cases with adverse effects of blood transfusion or blood product administration ,were compared. Results：Jaundice remission time in ET group was obviously shorter than that in non ET group（P＜0.05）.The ratio of cases with abnormal BAEP during hospitalization in ET group(3/25 cases) was lower than that in non ET group(12/20 cases)（P=0.092） but without statistic significance. No difference was found between the two groups as to the ratio of cases with abnormal head MRI, NBNA, BAEP at revisit ,and the ratio of cases with adverse effects of blood transfusion or blood products administration（P＞0.05）. After 3 months (＜4 months), No certain and probable cases of kernicterus were found in both groups; The ratio of cases with possible kernicterus in ET group (2 /24 cases) was lower than that in non ET group(7 /20 cases) but without statistic significance（P=0.079）;Among the 2 possible kernicterus cases in ET group there was one case with abnormal BAEP and one case with abnormal MRI, which were both abnormal during hospitalization; Among the 7 possible kernicterus cases in non ET group, there were 3 cases with abnormal MRI, 2 case with abnormal BAEP, and 2 case with abnormal MRI and BAEP simultaneously, which were exclusively abnormal during hospitalization; No abnormal MRI or BAEP cases were found among those whose MRI or BAEP were normal during hospitalization. Most cases （8/12）with abnormal BAEP during hospitalization in non ET group recovered at revisit after 3 months (＜4 months). Conclusion：When TSB level declines below ETT but the decline degree is within 34 μmol/L in IHH newborns (gestatinal age ≥ 35 weeks) without ABE after 6 hours extensive phototherapy, It can not be confirmed that ET can prevent hearing injury and neural abnormality in this specific situation, although ET can reduce jaundice remission time. ET among these specific newborns should be cautiously administrated

点击下载DOC全文 

主管单位：上海市卫生健康委员会  主办单位：上海市医学会
©2025《上海医学》编辑部 沪ICP备09078599号
您是本站第33174003名访问者
网站管理