發(fā)布時間：2018-06-06 16:05

  本文選題：換血療法 + 高膽紅素血癥��； 參考：《重慶醫(yī)科大學》2014年碩士論文

【摘要】：目的探討新生兒高膽紅素血癥的病因及危險因素，因換血可能發(fā)生的不良反應(yīng)，以及預(yù)后不良的危險因素。 方法納入重慶醫(yī)科大學附屬兒童醫(yī)院2001年1月至2011年12月間收治的，入院診斷為高膽紅素血癥并接受換血療法的足月新生兒609例。記錄患兒一般情況、伴隨疾病、換血前膽紅素峰值水平、換血情況、臨床轉(zhuǎn)歸等情況。 結(jié)果患兒的胎齡是39.1±2.6周，黃疸出現(xiàn)時間在35.5±22.6h，入院時年齡84.1±40h，換血前膽紅素峰值在455.2117.8μmol/L。其中361例(59.3%)患兒發(fā)生ABE，44例(7.2%)患兒預(yù)后不良。新生兒高膽紅素血癥的仍以ABO溶血為主，占60.9%，其次為病因不明(15.8%)，這其中可能有13.5%(13例)的新生兒是因為體重丟失過多而發(fā)生高膽紅素血癥血癥。換血相關(guān)副反應(yīng)以血小板減少為主，嚴重不良反應(yīng)的發(fā)生率為7.2%，以呼吸暫停最為常見，沒有患兒因換血而直接死亡。黃疸病因、換血前膽紅素峰值、換血時機對患兒的預(yù)后有顯著影響。 結(jié)論ABO溶血仍是新生兒嚴重高膽紅素血癥最常見的病因，對原因不明的嚴重黃疸患兒需注意其喂養(yǎng)及體重變化情況，，體重丟失過多可能是其發(fā)生高膽紅素血癥的唯一病因；換血相關(guān)的主要不良反應(yīng)以血液學指標異常為主，且是可治療的，但仍有可能發(fā)生嚴重不良反應(yīng)，且黃疸患兒病情越重，發(fā)生換血相關(guān)嚴重不良反應(yīng)的可能性越大。黃疸病因、換血前膽紅素峰值、換血時機對患兒的預(yù)后有顯著影響，對已達到換血標準的高膽紅素血癥患兒需及時換血。
[Abstract]:Objective to explore the etiology and risk factors of neonatal hyperbilirubinemia, the possible adverse reactions due to exchange transfusion, and the risk factors of poor prognosis.
Methods a total of 609 full-term neonates with hyperbilirubinemia and changing blood therapy were admitted to the Affiliated Children's Hospital of Medical University Of Chongqing from January 2001 to December 2011. The general condition of the children was recorded, with the disease, the peak level of pre exchange bilirubin, the change of blood, and the clinical outcome.
Results the gestational age of the children was 39.1 + 2.6 weeks, the onset time of jaundice was 35.5 + 22.6h, the age was 84.1 + 40H, the peak value of pre exchange bilirubin in 361 cases (59.3%) was ABE, 44 cases (7.2%) had poor prognosis. The neonatal hyperbilirubinemia was still mainly ABO hemolysis, accounting for 60.9%, followed by unknown etiology (15.8%). There may be 13.5% (13 cases) of neonatal hyperbilirubinemia due to excessive loss of weight. Blood transfusion related side effects are mainly thrombocytopenia, and the incidence of severe adverse reactions is 7.2%. The most common adverse reaction is apnea, and no children are dying directly from change of blood. The cause of jaundice, the peak of pre exchange bilirubin and the time of changing blood It has a significant impact on the prognosis of children.
Conclusion ABO hemolysis is still the most common cause of severe hyperbilirubinemia in newborns. Children with unexplained severe jaundice need to pay attention to their feeding and body weight changes. Too much loss of weight may be the only cause of hyperbilirubinemia. The main adverse reaction of blood exchange should be mainly with abnormal hematological indexes and can be treated as a cure. But there is still a serious adverse reaction, and the more serious the illness of the children with jaundice is, the greater the possibility of severe adverse reaction. The cause of jaundice, the peak value of the pre transfusion bilirubin, the timing of the change of blood have a significant influence on the prognosis of the children, and the children who have reached the standard of blood exchange need to change the blood in time.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R722.17

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本文編號：1987300