达换血水平的足月儿重度高胆红素血症治疗及预后:多中心回顾性研究  

Treatment and prognosis of severe hyperbilirubinemia in full-term infants meeting exchange transfusion criteria:a multicenter retrospective study

作　　者：李玲[1] 朴梅花[2] 郭玮[1] 王敬群[1] 耿淑霞[1] 杨梅[3] 何心[3] 翟淑芬[4] 平莉莉[4] 田宝丽[4] 梁丽霞[5] 刘芳 吕少广 范雪爱 回立远 刘丽艳 谷晓虹 王晓娇 康静 Li Ling;Piao Meihua;Guo Wei;Wang Jingqun;Geng Shuxia;Yang Mei;He Xin;Zhai Shufen;Ping Lili;Tian Baoli;Liang Lixia;Liu Fang;Lyu Shaoguang;Fan Xueai;Hui Liyuan;Liu Liyan;Gu Xiaohong;Wang Xiaojiao;Kang Jing(Department of Neonatology,Xingtai People's Hospital,Xingtai 054001,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China;Department of Neonatology,Baoding First Central Hospital,Baoding 071051,China;Department of Neonatology,Handan Central Hospital,Handan 056001,China;Department of Neonatology,Hengshui Harrison International Peace Hospital,Hengshui 053000,China;Department of Neonatology,the 980th Hospital of the People's Liberation Army Joint Support Force,Shijiazhuang 050082,China;Department of Neonatology,Xingtai Third Hospital,Xingtai 054001,China;Department of Neonatology,Zhangjiakou Maternal and Child Health Care Hospital,Zhangjiakou 075000,China)

机构地区：[1]邢台市人民医院新生儿科,054001 [2]北京大学第三医院儿科,100191 [3]保定市第一中心医院新生儿科,071051 [4]邯郸市中心医院新生儿科,056001 [5]衡水哈励逊国际和平医院新生儿科,053000 [6]联勤保障部队第980医院新生儿科,石家庄050082 [7]邢台市第三医院新生儿科,054001 [8]张家口妇幼保健院新生儿科,075000

出　　处：《中华围产医学杂志》2021年第6期454-460,共7页Chinese Journal of Perinatal Medicine

基　　金：河北省医学科学研究重点课题计划(ZD20140184)。

摘　　要：目的探讨换血法和光疗法治疗达换血水平的足月重度高胆红素血症患儿的预后及预后不良的高危因素。方法回顾性纳入2017年6月至2018年12月河北省7家三级医院新生儿科收治的达换血水平的重度高胆红素血症足月儿168例,按照治疗方式分为换血组(38例)和光疗组(130例)。采用两独立样本t检验、χ^(2)检验比较2组患儿的临床特点及随访结果。采用多因素logistic回归分析预后不良的高危因素。结果换血组和光疗组重度高胆红素血症原因前3位均为溶血病[42.1%(16/38)和29.2%(38/130)]、败血症[28.9%(11/38)和11.5%(15/130)]和早发型母乳性黄疸[15.8%(6/38)和11.5%(15/130)]。换血组治疗前血清总胆红素水平明显高于光疗组[(531.7±141.3)与(440.0±67.4)μmol/L,t=3.870,P<0.001],轻、中、重度急性胆红素脑病比例也高于光疗组[15.8%(6/38)与3.8%(5/130),7.9%(3/38)与0.8%(1/130),13.2%(5/38)与0.0%(0/130);χ^(2)=29.119,P<0.001]。随访到135例患儿,随访月龄为18~36个月,共12例患儿预后不良(运动/语言发育落后或听力损伤),其中换血组4例(12.9%,4/31),光疗组8例(7.7%,8/104)。多因素logistic回归分析显示,对于达换血水平的足月重度高胆红素血症患儿,不换血仅光疗可增加预后不良的风险(OR=14.407,95%CI:1.101~88.528,P=0.042),入院时重度急性胆红素脑病也是预后不良的危险因素(OR=16.561,95%CI:4.042~67.850,P<0.001)。结论达换血水平的足月重度高胆红素血症患儿应积极换血治疗,尤其是入院时即发生重度急性胆红素脑病者,以改善预后。Objective To investigate the prognosis of severe hyperbilirubinemia in full-term infants who met the exchange transfusion criteria and were treated by blood exchange transfusion and phototherapy.Methods A total of 168 full-term infants with severe hyperbilirubinemia who met the criteria for exchange transfusion and were hospitalized in the Neonatology Department of seven tertiary hospitals in Hebei Province from June 2017 to December 2018 were retrospectively included.According to the treatment protocol,they were divided into two groups:exchange transfusion group(38 cases)and phototherapy group(130 cases).Two independent sample t-test and Chi-square test were used to compare the clinical manifestations and follow-up results between the two groups.Multivariate logistic regression was used to analyze the risk factors for poor prognosis.Results Neonatal severe hyperbilirubinemia in the exchange transfusion and phototherapy group were both mainly caused by hemolytic disease[42.1%(16/38)and 29.2%(38/130)],sepsis[28.9%(11/38)and 11.5%(15/130)]and early-onset breastfeeding jaundice[15.8%(6/38)and 11.5%(15/130)].Total serum bilirubin level on admission in the exchange transfusion group was significantly higher than that in the phototherapy group[(531.7±141.3)vs(440.0±67.4)μmol/L,t=3.870,P<0.001].Moreover,the percentage of patients with mild,moderate and severe acute bilirubin encephalopathy in the exchange transfusion group were higher than those in the phototherapy group[15.8%(6/38)vs 3.8%(5/130),7.9%(3/38)vs 0.8%(1/130),13.2%(5/38)vs 0.0%(0/130);χ^(2)=29.119,P<0.001].Among the 168 patients,135 were followed up to 18-36 months of age and 12 showed poor prognosis(developmental retardation or hearing impairment)with four in the exchange transfusion group(12.9%,4/31)and eight in the phototherapy group(7.7%,8/104).Multivariate logistic regression analysis showed that for full-term infants with severe hyperbilirubinemia who met the exchange transfusion criteria,phototherapy alone without blood exchange transfusion as wel

关 键 词：高胆红素血症 新生儿 交换输血 全血 预后 回顾性研究 

分 类 号：R722.1[医药卫生—儿科]