本文選題：換血療法 + 高膽紅素血癥��； 參考：《重慶醫(yī)科大學(xué)》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(xiǎn)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(xiǎn)因素。 方法納入重慶醫(yī)科大學(xué)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(shí)間在35.5±22.6h，入院時(shí)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?yàn)轶w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(yán)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(shí)機(jī)對(duì)患兒的預(yù)后有顯著影響。 結(jié)論ABO溶血仍是新生兒嚴(yán)重高膽紅素血癥最常見的病因，對(duì)原因不明的嚴(yán)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(xué)指標(biāo)異常為主，且是可治療的，但仍有可能發(fā)生嚴(yán)重不良反應(yīng)，且黃疸患兒病情越重，發(fā)生換血相關(guān)嚴(yán)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(shí)機(jī)對(duì)患兒的預(yù)后有顯著影響，對(duì)已達(dá)到換血標(biāo)準(zhǔn)的高膽紅素血癥患兒需及時(shí)換血。
[Abstract]:Objective to explore the etiology and risk factors of neonatal hyperbilirubinemia, possible adverse reactions due to exchange of blood, and risk factors for poor prognosis. Methods the patients were admitted to the Children's Hospital affiliated to Chongqing Medical University from January 2001 to December 2011. 609 term neonates who were diagnosed as hyperbilirubinemia and received exchange therapy were admitted to hospital. Results the gestational age was 39.1 鹵2.6 weeks, the onset time of jaundice was 35.5 鹵22.6 h, the age of admission was 84.1 鹵40 h, and the peak of bilirubin before exchange was 455.2117.8 渭 mol / L. The prognosis was poor in 361 cases (59.3%). ABO hemolysis was the main cause of neonatal hyperbilirubinemia, accounting for 60.9%, followed by 15.8 cases of unknown etiology, of which 13 cases may have hyperbilirubinemia due to excessive weight loss. Thrombocytopenia was the main side effect of hemodialysis, and the incidence of serious side effects was 7.2. Apnea was the most common, and no children died directly as a result of exchange of blood. Conclusion ABO hemolysis is still the most common cause of severe hyperbilirubinemia in neonates. Children with severe jaundice with unknown causes should pay attention to their feeding and weight change. Excessive weight loss may be the only cause of hyperbilirubinemia. It is treatable, but it is still possible to produce serious adverse reactions, and the more serious the condition of children with jaundice, the more likely it is to have serious adverse reactions related to blood exchange. The causes of jaundice, the peak value of bilirubin before blood exchange, the timing of blood exchange had significant influence on the prognosis of children, and the patients with hyperbilirubinemia who had reached the standard of exchange of blood needed to exchange blood in time.
【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
【分類號(hào)】：R722.17

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本文編號(hào)：1987301