新生儿ABO血型不合溶血病伴重症高胆红素血症诊治的质量改进  

Quality improvement of diagnosis and treatment of ABO incompatible hemolytic disease with severe hyperbilirubinemia in neonates

作　　者：王乃玉 杨树杰[2] 甘斌[2] 何源[2] 张萍 杨朦 李磊[2] WANG Nai-yu;YANG Shu-jie;GAN Bin;HE Yuan;ZHANG Ping;YANG Meng;LI Lei(Jinzhou Medical University,Jinzhou,Liaoning 121001,China;不详)

机构地区：[1]锦州医科大学,辽宁锦州121001 [2]武汉科技大学附属孝感医院新生儿科,湖北孝感432000

出　　处：《中国临床研究》2023年第1期55-59,共5页Chinese Journal of Clinical Research

基　　金：湖北省卫生计生指导性项目(WJ2019F123)。

摘　　要：目的探讨质量改进对新生儿ABO血型不合溶血病(ABO-HDN)伴重症高胆红素血症(HB)诊治的意义。方法制定ABO-HDN管理质量改进方案,前瞻性选择2019年1月至2021年8月武汉科技大学附属孝感医院新生儿科收治ABO-HDN伴重症HB 45例患儿为研究组,回顾性收集2016年1月至2018年12月收治ABO-HDN伴重症HB 47例患儿为对照组。主要观察指标为ABO-HDN诊断时日龄、启动光照疗法时间、换血治疗率、急性胆红素脑病发生率。结果与对照组比较,研究组孕母抗体滴度筛查率提高(91.1%vs 70.2%),发现患儿黄疸的日龄提前[(18.8±12.4)h vs(32.3±18.4)h]、患儿入院日龄提前[(32.4±20.6)h vs(50.2±36.8)h]、ABO-HDN诊断时日龄提前[(35.8±24.3)h vs(52.6±38.2)h]、入院时总胆红素降低和血红蛋白升高,入院启动光疗时间提前[(10.0±5.2)min vs(30.0±7.1)min],差异均有统计学意义(P<0.01);研究组光照疗法时间、换血治疗发生率(0 vs 10.64%)、急性胆红素脑病发生率(4.44%vs 6.38%)均较对照组有所降低,但差异无统计学意义(P>0.05)。结论质量改进利于ABO-HDN早诊断及快速有效治疗,可以避免ABO-HDN伴重症HB的换血治疗,且不增加急性胆红素脑病发生。Objective To explore the significance of quality improvement in the diagnosis and treatment of ABO hemolytic disease of newborn(ABO-HDN)with severe hyperbilirubinemia(HB).Methods Fourty-five newborn with ABO-HDN and severe HB were prospectively selected as study group,who were admitted to Xiaogan Hospital affiliated to Wuhan University of Science and Technology from January 2019 to August 2021,for whom ABO-HDN management quality improvement program was formulated and implemented,and 47 newborn with the same disease treated from January 2016 to December 2018 were served as control group for retrospective analysis.The main outcome measures were day age at diagnosis,time to start light therapy,rate of blood exchange therapy and incidence of acute bilirubin encephalopathy(ABE).Results Compared with those in control group,the screening rate of maternal antibody titer increased(91.1%vs 70.2%),the time of discovery of neonatal jaundice[(18.8±12.4)h vs(32.3±18.4)h],admission time[(32.4±20.6)h vs(50.2±36.8)h],ABO-HDN diagnosis time[(35.8±24.3)h vs(52.6±38.2)h]and the time of initiation of phototherapy[(10.0±5.2)min vs(30.0±7.1)min]were earlier,the level of total serum bilirubin(TSB)decreased,and the hemoglobin level increased at admission in study group(P<0.01).The time of light therapy and the incidences of blood exchange therapy(0 vs 10.64%)and ABE(4.44%vs 6.38%)in study group were lower than those in control group,but there were no statistical differences in them(P>0.05).Conclusion The quality improvement is beneficial to the early diagnosis and rapid and effective treatment of ABO-HDN,can avoid exchange transfusion without increasing the occurrence of ABE in the treatment of ABO-HDN with severe HB.

关 键 词：溶血病 ABO血型不合 新生儿 质量改进 诊断 换血治疗 

分 类 号：R722.18[医药卫生—儿科]