CAJ | 학술논문

目的：探讨足月儿重度高胆红素血症不同治疗方法的预后及常见病因。方法回顾分析我院新生儿中心2011年6月—2013年6月收治的血清总胆红素(total serum bilirubin, TSB)≥342.2μmol/L的足月患儿113例,予常规治疗44例(常规组)及在此基础上予全血置换术治疗69例(换血组),比较两组病因及预后。结果本研究两组孕周、出生体重、生产方式及入院时TSB比较差异均无统计学意义( P>0．05),具有可比性。病因以同族免疫性溶血占首位(51例,45.13%),其中换血组27例(52.94%),常规组24例(43.63%),差异有统计学意义(P<0．05)；换血组无母乳性黄疸及无原因健康足月黄疸儿,与常规组比较差异亦有统计学意义(P<0．05)；两组感染相关性黄疸儿及围产相关因素黄疸儿比例差异无统计学意义(P>0．05)。平均日龄换血组与常规组比较差异有统计学意义(P<0．05)；对母乳喂养、健康足月无明显原因的重度黄疸儿予常规治疗并不增加胆红素脑病的发生率,而对溶血、感染等病因导致的重度高胆红素血症患儿积极的换血治疗则可防止或减少胆红素脑病的发生。结论接诊重度高胆红素血症患儿应尽早明确病因并积极对因治疗,对溶血、日龄<7d的患儿行换血治疗可减少胆红素脑病的发生,相反对母乳喂养及无明显病理因素的重度高胆红素血症患儿予常规治疗预后良好。
목적：탐토족월인중도고담홍소혈증불동치료방법적예후급상견병인。방법회고분석아원신생인중심2011년6월—2013년6월수치적혈청총담홍소(total serum bilirubin, TSB)≥342.2μmol/L적족월환인113례,여상규치료44례(상규조)급재차기출상여전혈치환술치료69례(환혈조),비교량조병인급예후。결과본연구량조잉주、출생체중、생산방식급입원시TSB비교차이균무통계학의의( P>0．05),구유가비성。병인이동족면역성용혈점수위(51례,45.13%),기중환혈조27례(52.94%),상규조24례(43.63%),차이유통계학의의(P<0．05)；환혈조무모유성황달급무원인건강족월황달인,여상규조비교차이역유통계학의의(P<0．05)；량조감염상관성황달인급위산상관인소황달인비례차이무통계학의의(P>0．05)。평균일령환혈조여상규조비교차이유통계학의의(P<0．05)；대모유위양、건강족월무명현원인적중도황달인여상규치료병불증가담홍소뇌병적발생솔,이대용혈、감염등병인도치적중도고담홍소혈증환인적겁적환혈치료칙가방지혹감소담홍소뇌병적발생。결론접진중도고담홍소혈증환인응진조명학병인병적겁대인치료,대용혈、일령<7d적환인행환혈치료가감소담홍소뇌병적발생,상반대모유위양급무명현병리인소적중도고담홍소혈증환인여상규치료예후량호。
Objective To study the main cause of severe hyperbilibrubinemia in full-term infants and prognosis. Methods During June 2011 and June 2013, 113 full term infants with the serum total bilirubin level ≥342. 2 μmol/L in newborn service of tertiary hospitals were included, 44 cases (38. 94%) received exchange transfusion, 69 cases (61. 06%) received only phototherapy ( routine therapy group); the common causes, treatment and clinical outcomes were analyzed. Results There were no significant differences of gestational weeks, birth weight, birth approach and the TSB before admis-sion to hospital between the two groups with comparability (P>0. 05). In 113 cases, 51 cases (45. 13%) were iso-immune hemolytic diseases;There was 52. 94% (27/51) of the infants with iso-immune hemolytic diseases in exchange transfusion group, 43. 63% (24/51) in routine therapy group, and no breast-feeding jaundice and physiological jaundice in exchange transfusion group was found. There were no significant differences of infection-related jaundice and perinatal related jaundice between the two groups ( P >0. 05 ); The average age in exchange transfusion group and in routine therapy group showed difference with statistical significance (P<0. 05);Even without accepting exchange transfusion therapy, the full-term infants with severe hyperbilirubinemia due to breast-feeding and physiological factors did not develop chronic bilirubin encephalopa-thy;But for the severe hyperbilirubinemia due to hemolysis and infection, active exchange transfusion therapy could prevent or reduce the occurrence of bilirubin encephalopathy. Conclusion Treatment options for infants with severe hyperbilirubinemia should dependent on the causes and infant's age. For the severe hyperbilirubinemia cases due to hemolysis, and the fact that the patients are less than 7 days, exchange transfusion can reduce the incidence of bilirubin brain injury. Breast feeding to pa-tients of breast feeding or with non-pathological severe hyperbilirubinemia, routine treatment can have good prognosis.