母儿Rh血型不合新生儿围产期溶血相关指标分析及防治

The analyse of hemolysis-related indicators of newborn and control maternal-fetal Rh blood group incompatibility in the perinatal period and effective prevention

目的:探讨围产期相关检测指标对防治新生儿Rh溶血的指导意义。方法:选择中国人民解放军陆军军医大学西南医院近3年收治的46例母儿Rh血型不合新生儿。分析抗-D抗体效价、血红蛋白、血清胆红素等围产期溶血相关指标在致敏与未致敏新生儿、换/输血与未换/输血新生儿间的差异,探讨其对新生儿母儿Rh血型不合相关并发症防治的指导意义。结果:46例新生儿中,14例Rh溶血患儿需换/输血、输血浆等;12例Rh溶血症较轻,无需换/输血,仅需光照、补液支持;20例无溶血新生儿无需特殊处理。抗-D抗体效价、胎龄、血红蛋白、血清胆红素、肌酸激酶及其同工酶在致敏和未致敏患儿、换/输血与未换/输血患儿之间差异有统计学意义(P<0.05)。结论:通过对围产期抗-D抗体效价、血红蛋白、胆红素等溶血相关指标加强监测,有利于及时发现同种免疫性溶血可能患儿并及时防治。

Objective：To explore specific indications of RH blood group incompatibility during perinatal period for effective prevention and timely treatment of haemolytic disease of fetus and newborn.Methods：46 maternal-fetal Rhesus incompatible newborns in recent three years were collected in southwest hospital of Army Medical University of PLA.A retrospective analysis of hemolysis-related indicators during perinatal period was performed between sensitized group and nonsensitized group,groups with blood transfusions and without blood transfusion,including anti-D antibody titre,hemoglobin,dynamical serum bilirubin value and so on.The clinical significance in the detected indexes were studied for treatment and the further preventions the associated complications.Results：Of 46 infants,14 with severe anemia and/or hyperbilirubinemia treated by in-time exchange transfusion（ET）and plasma transfusion.12 infants of hyperbilirubinemia without obvious signs of hemolysis received complex management such as phototherapy,intravenous fluids and health support but ET.20 infants without existing alloantibodies didn＇t need any specific treatment.There were statistical differences in anti-D antibody titre,gestational age at birth,hemoglobin,serum-bilirubin,creatine kinase,creatine kinase isoenzyme among three groups（P〈0.05）.Conclusions：Intensive monitoring hematolytic indicators such as maternal anti-D antibody,fetal/neonatal hemoglobin and bilirubin can help find out newborns with severe alloimmune hemolytic disease and treat them timely.