新生儿溶血病的早期诊断治疗

Clinical analysis on early diagnosis and treatment of hemolytic disease of newborn

目的探讨新生儿溶血病的早期诊断方法和治疗效果。方法凡查出孕妇血型为O或Rh阴性,并与丈夫血型不合,且抗A(或B)效价>1∶64,或抗Rh效价>1∶8,分娩时常规留取脐静脉血3ml,送验血型和溶血三项试验,确诊为母婴血型不合溶血病的不等黄疸出现,立即开始治疗,作为早治组。孕妇未作血型检查,其新生儿出现病理性黄疸后才确诊为新生儿溶血病而开始治疗的为对照组。比较两组新生儿黄疸持续时间、高峰期胆红素值、出生体重、胎龄以及换血例数、胆红素脑病发生例数等。结果十年间共诊断新生儿溶血病46例,其中早治组28例(ABO溶血病26例,Rh溶血病2例),对照组18例(ABO溶血病16例,Rh溶血病2例)。黄疸持续时间,早治组显著短于对照组(P<001)。高峰期胆红素值,两组比较差异无显著意义(P>005)。出生体重、胎龄,两组比较差异无显著意义(P>005)。对照组2例Rh溶血病均经换血治疗,1例发生胆红素脑病。早治组全部治愈,未经换血,无胆红素脑病发生。结论利用脐血检验能早期诊断新生儿溶血病;在黄疸出现前确诊并开始治疗,能显著缩短黄疸持续时间,减少换血治疗,防止胆红素脑病。

Objective To investgate early diagnosis and therapy of hemolytic disease of newborn(HDN).Methods When the expectant mothers were deliving with anti-A(B) IgG titer >64 or anti-Rh titer >8,we kept the blooding of the umbilicus to detect the blood type and hemolysis tests.Those newborns who were diagnosed HDN were treated before the appearance of jaundice.We looked them as group one.Another group of newborns were treated when the diagnosis of HDN was comfirmed after appearance of pathological jaundice.Then we contrasted the duration of jaundice,the number of bilirubin on peak time,birth weight,gestational age,the cases of exsanguinotransfusion treatment and kernicterus between the two groups.Results 46 cases hemolytic disease of newborn in the recent 10 years were divided into two groups.28 cases in group one(26 in ABO hemolytic and 2 in Rh hemolytic),18 cases in the control group(16 in ABO hemolytic and 2 in Rh hemolytic).The duration of jaundice was shortened significantly in group one(P<0.01).And they were all healed who didn't be treated by exsanguinotransfusion and appear kernicterus.There were no significant differences in the number of bilirubin on peak time,birth weight and gestational age(P>0.05).Conclusions Early diagnosis and therapy of HDN can shorten significantly the duration of jaundice and reduce the cases of exsanguinotransfusion treatment and appearance of kernicterus.