替比夫定阻断乙型肝炎病毒母婴传播的效果及护理分析

Effect of telbivudine in blocking the maternal-neonatal transmission of hepatitis B virus and nursing analysis

目的:探讨替比夫定阻断乙型肝炎病毒母婴传播的效果及护理干预方法。方法:选择本院收治的HBV携带孕妇100例,随机分为观察组与对照组各50例,观察组在孕28周开始口服替夫定600mg/次,每天一次,至分娩后1个月停药,并在产前、产时和产后进行有针对性的护理干预;对照组不给予替比夫定阻断治疗;两组孕妇所生婴儿于出生后即刻、1月龄是分别注射乙肝免疫球蛋白(HBIG)200IU/次,出生即刻、1个月、6个月时按程序接种重组乙型肝炎疫苗(Hebd)10μg/次,进行联合阻断。对比两组患者治疗前、分娩后血清HBcAb、HBeAg、HBV-DNA水平变化,并于婴儿出生后及6、12月龄取血测HBsAg,对比两组阳性率差异。结果:两组治疗前血清HBcAb、HBeAg、HBV-DNA水平比较,差异无统计学意义(P>0.05);分娩前各项指标较治疗前明显下降,差异具有统计学意义(P<0.05);观察组分娩前血清HBeAg、HBV-DNA水平明显低于对照组,差异具有统计学意义(P<0.05);两组分娩前血清HBcAb水平比较,差异无统计学意义(P>0.05);观察组出生后24h内、6个月及12个月HBsAg和HBV-DNA阳性率均明显低于对照组,差异具有统计学意义(P<0.05)。结论:替比夫定联合HBIG、Hepd可有效阻断HBV母婴传播,减少婴儿HBsAg、HBV-DNA阳性率,同时配合有针对性护理干预,可有效的提高了母婴HBV阻断率,降低母婴垂直传播的发生机率。

Objective：To explore the effect of telbivudine in blocking the maternal-neonatal transmission of hepatitis B virus（HBV）and the method of nursing intervention.Methods：A total of 100 pregnant women carrying HBV admitted in our hospital were enrolled in our study and randomized into the observation group and the control group with 50 cases in each group.The pregnant women in the observation group were orally given telbivudine（600mg/time）,once every day from the28 th week of gestation and the drug was withdrawn until one week after delivery;meanwhile,targeted nursing interventions were performed before deliver,the time of delivery,and after delivery.The patients in the control group were not given telbivudine-blocking treatment.The infants delivered by the pregnant women in the two groups were injected with HBIG（200IU/time）the time immediately after birth and one month after birth,and were programmed to be inoculated with Hebd（10ug/time）the time immediately after birth,one month and six months after birth,respectively,in order to blocking the transmission.The changes of serum HBcAb,HBeAg,and HBV-DNA levels in the two groups before treatment and after delivery were compared.The blood was taken from the infants the time after birth,six and twelve months after birth to determine the HBsAg level,and the difference of positive rate between the two groups was compared.Results：The comparison of serum HBcAb,HBeAg,and HBV-DNA levels in the two groups before treatment was not statistically different（P〉0.05）,but the various indicators before delivery was significantly reduced when compared with those before treatment（P〈0.05）.The serum HBeAg and HBV-DNA levels before delivery in the observation group were significantly lower than those in the control group（P〈0.05）;and there was not a statistical difference of serum HBcAb level before delivery between the two groups（P〉0.05）.The positive rates of HBsAg and HBV-DNA in the infants 24 hwithin birth,6and 12 months after birth in the observation group were significantly lower than those in the control group（P〈0.05）.Conclusions：Telbivudine in combined with HBIG and Hepd can effectively block the maternal-neonatal transmission of HBV,and reduce the positive rates of HBsAg、HBV DNA in the infants;meanwhile,inclusion of targeted nursing interventions can effectively enhance the blocking rate of maternal-neonatal transmission of HBV,and lessen the occurrence rate of vertical transmission.：