CAJ | 학술논문

目的：比较换血疗法（ET ）治疗不同程度急性胆红素脑病（ABE）的成本效益，为 ABE干预方案的选择提供参考。方法回顾性分析2009～2010年该中心137例 ABE患儿的临床资料。轻度 ABE换血组（SE组）40例、轻度 ABE非换血组（SNE组）29例、中重度ABE换血组（ME组）49例和中重度ABE非换血组（MNE组）19例。结果 SE组血清总胆红素（TSB）、TSB与血浆清蛋白的比值（B/A）、新生儿溶血病比例和人均住院费用均明显高于SNE组（P＜0．05），无死亡发生，不良预后发生率15．0％与SNE组13．8％相似；最大效益成本比分别为87．5和121．5。ME组TSB、B/A、新生儿溶血病比例和人均住院费用均显著高于MNE组（P＜0．05）；5例死亡，死亡-不良预后发生率32．7％，为MNE组15．8％的2．1倍；最大效益成本比分别为89．8和160．0。ME组TSB、B/A高于SE组（P＜0．05），死亡-不良预后发生率为SE组的2．2倍，换血疗法相关严重不良反应发生率12．2％为SE组5．0％的2．4倍，人均住院费用与SE组相似（P＞0．05）。结论换血疗法对于轻度ABE的成本效益较好，可作为抢救治疗的首选；中重度ABE尤其是重度ABE需权衡利弊。新生儿病理性黄疸尽早光疗，避免或减轻ABE ，降低死亡-不良预后发生率，减少资源消耗和经济损失。
목적：비교환혈요법（ET ）치료불동정도급성담홍소뇌병（ABE）적성본효익，위 ABE간예방안적선택제공삼고。방법회고성분석2009～2010년해중심137례 ABE환인적림상자료。경도 ABE환혈조（SE조）40례、경도 ABE비환혈조（SNE조）29례、중중도ABE환혈조（ME조）49례화중중도ABE비환혈조（MNE조）19례。결과 SE조혈청총담홍소（TSB）、TSB여혈장청단백적비치（B/A）、신생인용혈병비례화인균주원비용균명현고우SNE조（P＜0．05），무사망발생，불량예후발생솔15．0％여SNE조13．8％상사；최대효익성본비분별위87．5화121．5。ME조TSB、B/A、신생인용혈병비례화인균주원비용균현저고우MNE조（P＜0．05）；5례사망，사망-불량예후발생솔32．7％，위MNE조15．8％적2．1배；최대효익성본비분별위89．8화160．0。ME조TSB、B/A고우SE조（P＜0．05），사망-불량예후발생솔위SE조적2．2배，환혈요법상관엄중불량반응발생솔12．2％위SE조5．0％적2．4배，인균주원비용여SE조상사（P＞0．05）。결론환혈요법대우경도ABE적성본효익교호，가작위창구치료적수선；중중도ABE우기시중도ABE수권형리폐。신생인병이성황달진조광료，피면혹감경ABE ，강저사망-불량예후발생솔，감소자원소모화경제손실。
Objective To assess the cost-benefit of exchange transfusion(ET ) in the treatment of different severity of acute bili-rubin encephalopathy(ABE) .Methods Retrospective analysis was carried out on the clinical data of 137 ABE from January 2009 to December 2010 .The enrolled neonates were divided into four groups by ABE severity and interventions :40 neonates in Group SE (Subtle ABE with ET ) ,29 in Group SNE (Subtle ABE without ET ) ,49 in Group ME (Moderate to advanced ABE with ET ) ,and 19 in Group MNE (Moderate to advanced ABE without ET ) .Results The Total Serum Bilirubin (TSB) levels ,the ratio of TSB and plasma albumin (B/A) ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group SE were significantly higher than those in Group SNE (P<0 .05) .Without death in subtle ABE ,the rate of poor outcomes in Group SE , 15 .0% was similar to that of Group SNE ,13 .8% .The maximum benefit-cost ratio of Group SE and Group SNE was 87 .5 and 121 .5 ,respectively .The TSB levels ,B/A ,the proportion of neonatal hemolysis disease and the hospitalization costs per capita in Group ME significantly higher those in Group MNE (P<0 .05) .5 neonates died in moderate to advanced ABE ,and the incidence of poor outcomes in Group ME ,32 .7% was 2 .1 times to that of Group MNE ,15 .8% .The maximum benefit-cost ratio of Group ME and Group MNE was 89 .8 and 160 .0 ,respectively .The TSB levels and B/A in Group ME significantly higher those in Group SE (P<0 .05) ,the incidence of poor outcomes in Group ME was 2 .2 times to that of Group SE ,whereas the hospitalization costs per capita in Group ME were similar to those in Group SE (P>0 .05) .Morbidity of the severe adverse events associated with ET in Group ME ,12 .2% was 2 .4 times to that of Group SE ,5 .0% .Conclusion ET is worth of the first-line approach rescuing subtle ABE .However ,ET is needed to be weighted the advantages and disadvantages before performed on moderate or advanced ABE .It is necessary to implement phototherapy among neonates with pathologic jaundice ,which is crucial for diminishing mortality and mor-bidity of ABE and lowering medical resource consumption .