發(fā)布時(shí)間：2018-05-13 19:33

  本文選題：重度高膽紅素血癥 + 預(yù)后��； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的探討重度高膽紅素血癥患兒不良預(yù)后的原因及評(píng)估方法，為指導(dǎo)治療及改善預(yù)后提供依據(jù)。 方法搜集2012年1月-12月間在我院新生兒科住院的重度高膽紅素血癥患兒的病歷資料及隨訪(fǎng)結(jié)果進(jìn)行分析。 結(jié)果55.56%患兒入院前行膽紅素篩查，24小時(shí)及72小時(shí)內(nèi)篩查比例4.91%、33.13%。感染性病因（74.40%）及新生兒溶血�。�51.19%）為重度高膽紅素血癥主要病因，膽紅素峰值是其不良預(yù)后的獨(dú)立危險(xiǎn)因素。溶血組黃疸出現(xiàn)時(shí)齡、黃疸持續(xù)時(shí)間、入院時(shí)齡小于無(wú)溶血組，B/A值、換血率高于無(wú)溶血組。BIND（0-6）分不良預(yù)后較輕且有一定可逆性，BIND（7-9）分提示嚴(yán)重不良預(yù)后。不良預(yù)后組TSB峰值、UCB值、B/A值明顯高于無(wú)不良預(yù)后組，此三者評(píng)價(jià)不良預(yù)后的ROC曲線(xiàn)下面積分別為0.682、0.671、0.698，， TSB=474.5μmol/L，UCB=449.15μmol/L，B/A=0.923mg/g時(shí)約登指數(shù)最大。有無(wú)不良預(yù)后組BAEP、NBNA異常率及蒼白球信號(hào)改變率無(wú)統(tǒng)計(jì)學(xué)差異。有無(wú)神經(jīng)系統(tǒng)異常表現(xiàn)組OAE及BAEP異常率無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)論需加強(qiáng)并規(guī)范新生兒黃疸監(jiān)測(cè)、隨訪(fǎng)及診療，降低重度極重度高膽紅素血癥及核黃疸發(fā)病率。聽(tīng)力檢查結(jié)果與神經(jīng)系統(tǒng)表現(xiàn)不一致，需常規(guī)行聽(tīng)力檢查。BIND評(píng)分表評(píng)估不良預(yù)后特別是嚴(yán)重不良預(yù)后有較好價(jià)值。TSB峰值、UCB值、B/A值是不良預(yù)后指標(biāo)。未發(fā)現(xiàn)急性期NBNA、聽(tīng)力檢查結(jié)果及蒼白球T1WI高信號(hào)與遠(yuǎn)期預(yù)后明確相關(guān)，對(duì)預(yù)后評(píng)估的價(jià)值需進(jìn)一步研究。
[Abstract]:Objective to explore the causes and methods of poor prognosis in children with severe hyperbilirubinemia and to provide evidence for guiding treatment and improving prognosis. Methods the medical records and follow-up results of severe hyperbilirubinemia hospitalized in our hospital from January to December 2012 were analyzed. Results the proportion of bilirubin screening within 24 hours and 72 hours before admission was 4.91% and 33.13% respectively. Infection with STDs (74.40) and neonatal hemolysis (51.19) were the main causes of severe hyperbilirubinemia. The peak value of bilirubin was an independent risk factor for poor prognosis. In hemolytic group, the age of jaundice appeared, the duration of jaundice, the age of admission was less than that of no hemolysis group, and the rate of blood exchange was higher than that of non-hemolytic group. The TSB peak value and B / A value of poor prognosis group were significantly higher than that of no poor prognosis group. The area under ROC curve of the three groups was 0.682n 0.671g / g 0.698, and TSB=474.5 渭 mol / L UCBR 449.15 渭 mol 路L ~ (-1) 路L ~ (-1) B ~ (-1) = 0.923 mg 路g ~ (-1) 路g ~ (-1) ~ (-1). There was no significant difference in abnormal rate of BAEPN NBNA and signal change rate of globus pallidus in patients with poor prognosis. There was no significant difference in abnormal OAE and BAEP rates in patients with or without neurological abnormalities. Conclusion it is necessary to strengthen and standardize neonatal jaundice monitoring, follow up, diagnosis and treatment, and reduce the incidence of severe extremely severe hyperbilirubinemia and nuclear jaundice. The results of hearing examination were not consistent with those of nervous system. It was a good value to evaluate the poor prognosis, especially the severe bad prognosis. The UCB value and B / A value of UCB were the indexes of poor prognosis. No significant correlation was found between acute stage Nbna, hearing test results and high signal intensity in globus pallidus (T1WI). The value of NBNA in evaluation of prognosis should be further studied.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R722.1

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