换血治疗对新生儿胆红素脑病患儿并发症及预后的影响

Effect of exchange transfusion therapy on complications and prognosis in newborns with bilirubin encephalopathy

目的研究换血治疗对新生儿胆红素脑病患儿并发症及预后的影响。方法选取肥城市人民医院2013年6月至2016年6月收治的胆红素脑病患儿76例为观察对象,根据是否接受换血治疗分为研究组(n=41)和对照组(n=35),检测并比较两组总胆红素(TBIL)、间接胆红素(IBIL)、结合胆红素(DBIL)水平及血总胆红素与血浆白蛋白比值(B/A),记录两组并发症、预后情况。结果研究组换血后TBIL、IBIL、DBIL及B/A比值分别为(209.49±48.82)μmol/L、(201.81±39.62)μmol/L、(21.92±19.47)μmol/L及(5.15±1.89),均明显低于换血前的(492.35±42.41)μmol/L、(439.44±52.56)μmol/L、(69.38±21.56)μmol/L及(13.28±0.40)(t=28.007、23.117、10.461、26.947,均P<0.05);研究组贫血、窦性心动过缓以及电解质紊乱发生率分别为48.78%、48.78、60.98%,明显高于对照组的17.14%、14.29%、14.29%(χ^2=8.397、10.178、17.228,均P<0.05);研究组死亡、听力损害、脑损害发生率分别为7.32%、70.73%、12.20%,对照组分别为11.43%、71.43%和14.29%,两组差异均无统计学意义(χ^2=0.382、0.004、0.072,均P>0.05)。结论换血治疗新生儿胆红素脑病能显著降低胆红素水平和B/A比值,但会增加贫血、窦性心动过缓以及电解质紊乱的发生率,对预后无显著影响。

Objective To study the influence of exchange transfusion therapy on the complications and prognosis in newborns with bilirubin encephalopathy.MethodsFrom June 2013 to June 2016,76 children with bilirubin encephalopathy in Feicheng People's Hospital were selected and divided into study group(n=41)and control group(n=35)according to whether or not accepted the exchange transfusion treatment.The levels of total bilirubin(TBIL),indirect bilirubin(IBIL),direct bilirubin(DBIL)and the ratio of total bilirubin to plasma albumin(B/A)were detected and compared between the two groups.The complications and prognosis of the two groups were recorded.ResultsAfter exchange transfusion,the TBIL,IBIL,DBIL and B/A values in the study group were(209.49±48.82)μmol/L,(201.81±39.62)μmol/L,(21.92±19.47)μmol/L and(5.15±1.89),respectively,which were significantly lower than those before exchange transfusion[(492.35±42.41)μmol/L,(439.44±52.56)μmol/L,(69.38±21.56)μmol/L and(13.28±0.40)](t=28.007,23.117,10.461,26.947,all P<0.05).The incidence rates of anemia,sinus bradycardia and electrolyte disturbances in the study group were 48.78%,48.78,60.98%,respectively,which were significantly higher than those in the control group(17.14%,14.29%,14.29%)(χ^2=8.397,10.178,17.228,all P<0.05).The incidence rates of death,hearing impairment and brain damage in the study group were 7.32%,70.73%and 12.20%,respectively,which in the control group were 11.43%,71.43%and 14.29%,respectively,there were no statistically significant differences between the two groups(χ^2=0.382,0.004,0.072,all P>0.05).ConclusionExchange transfusion can significantly reduce the levels of bilirubin and B/A in the treatment of newborns with bilirubin encephalopathy,but it can increase the incidence rate of anemia,sinus bradycardia and electrolyte disturbances,which has no significant influence on the prognosis of patients.