换血治疗与晚期新生儿高胆红素血症临床预后的相关性研究  

Association between exchange transfusion and the clinical prognosis of hyperbilirubinemia in late newborns

作　　者：付华 罗丽娟 颜云 余志碧 董文斌 雷小平 Fu Hua;Luo Lijuan;Yan Yun;Yu Zhibi;Dong Wenbin;Lei Xiaoping(Department of Neonatology,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院新生儿科,泸州646000

出　　处：《中华新生儿科杂志(中英文)》2025年第4期203-208,共6页Chinese Journal of Neonatology

摘　　要：目的 探讨换血治疗能否改善晚期新生儿高胆红素血症的临床预后。方法 法选择2013年10月至2022年4月西南医科大学附属医院新生儿科、血清总胆红素达到2004年美国儿科学会推荐的换血干预曲线中7日龄换血阈值、无急性胆红素脑病(acutebilirubin encephalopathy,ABE)临床表现的晚期新生儿(日龄>7d)进行回顾性分析。根据是否接受换血治疗分为换血组和未换血组。采用多因素logistic回归模型调整可能的影响因素,比较两组临床预后和并发症的发生风险;基于观察性研究组间基线资料的差异,采用逆概率加权匹配进行敏感性分析验证结果的可靠性。结果 共纳人224例晚期新生儿,其中换血组67例,未换血组157例。两组患儿住院期间不良神经结局(ABE、头颅磁共振成像或振幅整合脑电图异常)(a0R=1.012,95%CI0.542~1.786)及1岁时临床结局(运动、语言发育迟缓、听力障碍、无热惊厥或死亡)(a0R=3.423,95%C/0.491~24.182)发生风险差异均无统计学意义(P>0.05),逆概率加权匹配后结果与未匹配前一致。与未换血组比较,换血组胆红素反弹率更低[14.9%(10/67)比36.9%(58/157)],光疗时间更短[96.0(72.0,144.0)h比96.0(72.0,120.0)h],但不良反应发生率增加[56.7%(38/67)比15.9%(25/157)],差异均有统计学意义(P<0.05)。两组住院时长差异无统计学意义(P>0.05)。结论 对于达到7日龄换血标准但无ABE临床表现的晚期新生儿,换血治疗并不能降低不良临床结局发生率。Objective To study whether exchange transfusion can improve the clinical prognosis of hyperbilirubinemia in late newborns.Methods The study subjects were late newborns(age>7 d)who were admitted to the Neonatology Department of the Affiliated Hospital of Southwest Medical University from October 2013 to April 2022,whose total serum bilirubin that met or exceed the exchange transfusion threshold for 7-day-old infants as recommended by the American Academy of Pediatrics in 2004 guidelines,and they had no clinical signs of acute bilirubin encephalopathy(ABE).According to whether they received exchange transfusion,the subjects were divided into exchange transfusion group and non-exchange transfusion group.After adjusting for potential influencing factors using a multivariate logistic regression model,the clinical prognosis and complications were compared between the two groups.For the differences in baseline data in the observational study,inverse probability weighted matching was used for sensitivity analysis to verify the reliability of the results.ResultssA total of 224 late newborns were included in this study,with 67 in the exchange transfusion group and 157 in the non-exchange transfusion group.There was no statistically significant difference in the risk of adverse neurological outcomes(ABE,abnormal cranial magnetic resonance imaging or amplitude-integrated electroencephalogram)during hospitalization(a0R=1.012,95%CI 0.542-1.786,P>0.05)and clinical outcomes(motor and language developmental delay,hearing impairment,no febrile seizure or death)that at one year of age(aOR=3.423,95%CI 0.491-24.182,P>0.05)between the two groups.The results after inverse probability weighted matching were consistent with those before matching.Compared with the non-exchange transfusion group,the exchange transfusion group had a lower rate of bilirubin rebound[14.9%(10/67)vs.36.9%(58/157)],a shorter phototherapy time[96.0(72.0,144.0)h vs.96.0(72.0,120.0)h].However,the incidence of side effects increased[56.7%(38/67)vs.15.9%(25/157)],and

关 键 词：高胆红素血症 换血 强光疗 晚期新生儿 逆概率加权匹配 

分 类 号：R722.17[医药卫生—儿科]