新生儿急性胆红素脑病227例临床分析_刘开珍VIP免费

临床儿科杂志第30卷第9期2012年9月JClinPediatrVol.30No.9Sep.2012·840·基金项目：重庆市卫生局基金项目(No.2012-2-101)通信作者：华子瑜电子信箱：ziyu_h@yahoo.com.cn新生儿急性胆红素脑病227例临床分析刘开珍何华云华子瑜重庆医科大学附属儿童医院新生儿中心(重庆400014)摘要：目的探讨新生儿急性胆红素脑病(ABE)的临床特点，为ABE的早期诊断、及时干预、有效评估提供经验，改善其预后。方法收集2009年1月—2010年12月住院的ABE新生儿临床资料，进行回顾性分析。结果共入选227例ABE新生儿，根据ABE临床评分表，轻、中、重度ABE分别为156例、55例和16例；院内死亡2例，失访40例，电话随访185例(死亡10例，不良转归33例)。黄疸的病因主要为ABO溶血症、Rh溶血症、葡萄糖-6-磷酸脱氢酶缺陷症(G6PDD)等溶血性疾病。血清总胆红素(TSB)为(469.36±107.54)μmol/L；随ABE程度加重，TSB和血浆白蛋白比值(B/A值)明显增高，脑干听觉诱发电位(BAEP)异常率和死亡-不良转归发生率均明显上升(P<0.05)。不良转归患儿B/A值[(0.959±0.232)mg/g]明显高于无不良转归者[(0.809±0.206)mg/g](t=3.57，P=0.001)，B/A值评价不良转归的ROC曲线下面积为0.703，最佳临界点为0.908mg/g。所有患儿入院即给予加强光疗，126例接受换血治疗，换血组与未换血组新生儿的ABE程度和后遗症发生率比较差异无统计学意义。结论ABE的临床量化评分结合新生儿黄疸诊疗方案的规范实施，有利于胆红素脑病的早期诊断和及时抢救；动态监测TSB、B/A值，结合BAEP等的密切随访，有利于对胆红素脑病高危儿进行早期评估、医学干预，并改善预后。[临床儿科杂志,2012,30(9):840-844][临床儿科杂志,2012,30(9):840-844]关键词：胆红素脑病；临床分析；新生儿中图分类号：R722文献标志码：A文章编号：1000-3606(2012)09-0840-05Clinicalanalysisofacutebilirubinencephalopathyin227neonatesLIUKai-zhen,HEHua-yun,HUAZi-yu(Depart-mentofNeonatology,Children'sHospitalofChongqingMedicalUniversity,Chongqing400014,China)Abstract:ObjectiveToanalyzetheclinicalfeaturesofneonatalacutebilirubinencephalopathy(ABE).MethodsFromJan2009toDec2010,atotalof227ABEneonateswereadmitted.Aretrospectivestudywasperformedfromtheirmedicalrecords.ResultsBasedontheclinicalscoresofABE,the227neonateswerecategorizedintothreegroupsbyseverityofABE,mild(n=156),moderate(n=55)andsevere(n=16).Except2infantswhodiedduringhospitalizationand40infantswhowerelosttofollowup,therest185infantswerefollowedupthroughphone,amongwhom10infantsdiedshortlyafterdischargeand33infantssurvivedwithpoorneurologicaloutcome.ThecausesofhemolyticjaundiceincludeABOincompatibility,Rhhemolysisandglucose-6-phosphatedehydrogenasedeficiency(G6PDD).Thetotalserumbilirubin(TSB)atadmissionwas(469.36±107.54)μmol/L.WiththeseverityofABEenhanced,TSBlevel,totalbilirubin/albuminmolarratio(B/A),incidenceofabnormalbrainstemauditoryevokedpotential(BEAP)andthemortality/morbidityratioincreasedsignificantly(P<0.05).TheB/Avalueofthosewithpooroutcome(0.959±0.232)wassignificantlyhigherthanthatofthecompletesurvivors(0.809±0.206)(t=3.57,P=0.001).WhenpredictingABEprognosiswithB/Avalue,theareaunderROCwas0.703andthecut-pointwas0.908mg/g.Besidesintensivephototherapy,126ofthemunderwentexchangetransfusionwithoutbetteroutcome.ConclusionsCom-binationofABEclinicalscoringandtherecommendedinterventionstrategyforneonataljaundicedoesassistinearlydiagnoseandtimelytreatmentofbilirubinencephalopathy.Closefollow-upandmonitoringofTSB,B/Avalue,BAEP,cranialmagneticresonanceimagingandneurodevelopmentassessmentarecrucialforABEneonatestoachievebetterprognosis.(JClinPediatr,2012,30(9):840-844)(JClinPediatr,2012,30(9):840-844)Keywords:bilirubinencephalopathy;clinicalanalysis;n...