足月儿溶血性高胆红素血症与胆红素脑病的关系

Relation of Hemolytic Hyperbilirubinemia and Bilirubin Encephalopathy in Full-term Infant

目的：研究足月儿溶血性高胆红素血症所致胆红素脑病的高危因素及干预标准。方法：对2000年至2004年间患溶血性高胆红素血症足月儿29例分为脑病组与无脑病组，比较两组的血清胆红素、间接胆红素／白蛋白（B／A）比值、开始治疗时间等与胆红素脑病的关系及两组急性期与远期预后。结果：血清总胆红素〉367．99μmol／L，尤为〉428．18μmol／L、B／A比值〉1、开始治疗时间〉48h，均与胆红素脑病密切相关。脑病急性期与远期预后均差。结论：为防止发生胆红素脑病，对患溶血性高胆红素血症之足月儿，当总胆红素257～324μmol／L、B／A〈1时，可仅做光疗；总胆红素343～428μmol／L时，若B／A〈1、开始治疗时间〈48h，应光疗及输白蛋白，若B／A≥1。或开始治疗时〉48h，应换血；当总胆红素≥428μmol／L时，无论B／A比值或开始治疗时间如何，均应迅速换血。

Objective： To study the high -risk factor and intervention criteria for bilirubin encephalopa- thy （ BE ） caused by hemolytic hyperbilirubinemia （ HH ） in full - term infants. Methods： 29 full - time infants with HH from 2000 to 2004 were divided into the bilirubin encephalopathy and the control, comparing serum bilirubin, bilirubin/albumin（ B/A ） rate, beginning treated time （BTT）, relationship with bilirubin encephalopathy, and prognosis acute phase and long - term. Results： Bilirubin 〉 367. 99μmol/L（ especially over 428. 18μmol/L）, B/A 〉 1 and BTT 〉 48h were closely associated with BE, the outcome of BE group was poor. Conclusion： To prevent BE, the infants can be treated with phototherapy only, when bilirubin is 256 ～ 342μmol/L, B/A 〈 1 ; if bilirubin is 343 ～428μmol/L,B/A 〈 1 and BTT 〈48h, the infants must receive blood transfusion; once bilirubin is ≥428μmol/L, blood transfusion must be done immediately disregarding B/A and BTT.