换血疗法治疗新生儿胆红素脑病对听力及神经行为发育的影响  

Effect of exchange transfusion in the treatment of neonatal bilirubin encephalopathy on auditory and neurobehavioral development

作　　者：谭秋月[1] 林超[2] TAN Qiu-yue;LIN Chao(1.Department of Pediatric ,The People＇s Hospital of Jianyang city;West China Hospital,Sichuan University,Chengdu Sichuan 610041,China)

机构地区：[1]简阳市人民医院儿科,四川简阳641400 [2]四川大学附属第二医院儿科,四川成都610041

出　　处：《临床和实验医学杂志》2018年第13期1428-1431,共4页Journal of Clinical and Experimental Medicine

基　　金：四川省卫生厅科研资助项目(编号:130528)

摘　　要：目的探讨换血疗法对新生儿胆红素脑病对听力及神经行为发育的影响。方法采用前瞻性研究方法纳入2010年1月至2015年6月简阳市人民医院新生儿科收治的81例胆红素脑病新生儿为对象,采用随机数字表法随机分为观察组和对照组:观察组37例,接受换血治疗;对照组44例,接受蓝光照射、0.9%氯化钠溶液灌肠等方案治疗。检测两组患儿治疗前、治疗6 h后总胆红素、血气指标。分别于患儿出生后72 h、12个月时进行脑干听觉诱发电位(BAEP)检查,于患儿12个月时应用Gesell婴幼儿发育量表检查量表测定行为发育商,应用0～12个月52项神经行为检查量表测评神经运动行为发育情况。结果 (1)观察组治疗6 h后总胆红素明显下降、血氧分压明显升高、血pH明显上升,与治疗前相比,差异有统计学意义(P<0.05);对照组上述指标未见明显变化(P>0.05)。(2)观察组12个月时,BAEP检查Ⅲ、Ⅴ波潜伏期,Ⅰ～Ⅴ波间期分别为(4.22±0.21)ms、(6.35±0.41)ms、(4.80±0.28)ms,均明显短于对照组[(4.45±0.38)ms、(6.62±0.41)ms、(4.99±0.41)ms],BAEP正常患儿比率明显高于对照组,上述差异均具有统计学意义(P<0.05)。(3)观察组12个月时,行为发育商、52项运动评分分别为(79.44±10.31)分、(83.86±10.21)分,均明显高于对照组[(69.41±10.25)分、(77.81±12.28)分],上述差异均具有统计学意义(P<0.05)。结论对胆红素脑病(警告期)患儿,应该积极采用换血疗法,方可有效抑制疾病对患儿听力、神经行为发育的影响。Objective To investigate the medium-term efficacy of exchange transfusion therapy for newborns with bilirubin encephalopathy（ warning period）. Methods Eighty-one newborns with bilirubin encephalopathy（ warning period） in our hospital from January 2010 to June 2015 were included. They were randomly divided into observation group and control group by random number table. Thirty-seven cases in the observation group were treated with exchange transfusion therapy,while 44 cases in the control group were treated with blue light irradiation and physiological saline enema. Serum bilirubin level and blood gas index were measured before and after 6 h treatment in two groups. Brainstem auditory evoked potential（ BAEP） in newborns 72 hours after delivery and at the age of 12 months were detected. Gesell Developmental Schedules was used to exam the developmental quotient（ DQ） of newborns and Amiel-Tison neurological asseement（ ATNA） was used to exam the neurological development of newborns at the age of 12 months. Results（1） Six hours after treatment,total bilirubin in the observation group decreased significantly,Pa O2 increased significantly,serum p H increased significantly compared with before treatment,the difference was statistically significant（ P〈0. 05）. The control group index showed no significant change（ P〈0. 05）.（2） At the age of 12 months,the latency of wave III and V,the interval of Ⅰ ～ Ⅴ were（ 4. 22 ± 0. 21） ms,（ 6. 35 ± 0. 41） ms and（ 4. 80 ± 0. 28） ms in the observation group,while those in the control group were（ 4. 45 ± 0. 38） ms,（ 6. 62 ± 0. 41） ms and（ 4. 99 ± 0. 41） ms,the differences in 2 groups were statistically significant（ P〈0. 05）.The ratio of newborns with normal BAEP in the observation group was significantly more than that in the control group（ P〈0. 05）.（3） At the age of 12 months,DQ and ATNA in the observation group were（ 79. 44 ± 10. 31） and（ 83. 86 ± 10. 21） ms,while in the control group were

关 键 词：新生儿 胆红素脑病 警告期 换血疗法 听力 神经行为 

分 类 号：R722.1[医药卫生—儿科]