改良“急救车处理”治疗新生儿严重高胆红素血症的临床应用

Clinical application of modified"crash-cart"approach in the treatment of severe hyperbilirubinemia

目的:探讨改良“急救车处理”方法治疗严重高胆红素血症患儿的临床疗效。方法:收集2019年1月至2021年3月武汉科技大学附属孝感医院新生儿科改良“急救车处理”方案治疗的严重高胆红素血症患儿病历资料,作为急救车治疗组;选取2017年1月至2018年12月收治的严重高胆红素血症病例作为常规治疗组。主要观察指标:血清总胆红素(TSB)水平、入院后启动加强光疗时间、急性胆红素脑病(ABE)转归。结果:纳入研究急救车治疗组112例(ABE 41例),常规治疗组121例(ABE 45例),两组患儿中仅常规治疗组换血治疗1例。急救车治疗组启动光疗时间短于常规治疗组[(8.5±2.2)h vs(28.0±7.1)h,P<0.01]。急救车治疗组入院后6,12,24,48,72 h血清总胆红素水平均低于常规治疗组,其中6,12 h差异有统计学意义(P<0.05);两组中血清TSB 342~427μmol/L患儿比较,急救车治疗组入院后6,12,24,48,72 h血清TSB水平均低于常规治疗组,仅6 h差异有统计学意义(P<0.05);血清TSB>427.5μmol/L患儿比较,急救车治疗组入院后6,12,24,48,72 h血清TSB水平均低于常规治疗组,其中6,12 h差异有统计学意义(P<0.01)。两组患儿中ABE患儿入院6,12 h BIND评分急救车治疗组低于常规治疗组,差异有统计学意义(P<0.05),生后2~3个月常规治疗组ABE患儿脑干听觉诱发电位(BAEP)异常比例高于急救车治疗组,差异有统计学意义(P<0.05),头颅MRI两组患儿异常比例差异无统计学意义(P>0.05)。结论:改良“急救车处理”能快速降低严重高胆红素血症患儿血清TSB,尤其是对危重高胆红素血症效果显著,可以减少换血治疗,对轻-中度ABE有较好的预防和治疗效果。

Objective:To explore the clinical efficacy of the improved"crash-cart"approach method in the treatment of children with severe hyperbilirubinemia.Methods:The medical records of children with severe hyperbilirubinemia treated by the modified"crash-cart"program from the department of neonatology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January2019 to March 2021,were included in this study and set as the emergency group.The patients with severe hyperbilirubinemia admitted from January 2017 to December 2018 were selected as the control group(receiving routine treatment).The total serum bilirubin,initiate enhanced phototherapy time after admission,and outcomes of acute bilirubin encephalopathy(ABE)were compared.Results:A total of 112 cases were included in the emergency group(41 cases of ABE),and 121 cases were in the routine group(45 cases of ABE,and 1 case with exchange transfusion).The time to start phototherapy in the emergency group was shorter than that in the conventional group as(8.5±2.2)min vs(28.0±7.1)min(P<0.01).The serum total serum bilirubin(TSB)levels in the emergency group at the end of 6,12,24,48,and 72 h after admission were lower than those in the control group,and the difference between 6 h and 12 h was statistically significant(P<0.05).In the children with serum TSB 342-427μmol/L,significant difference was found at 6 h between the two groups in serum TSB levels(P<0.05);While in the children with serum TSB>427.5μmol/L,significant difference was found at 6 h and 12 h between the two groups in serum TSB levels(P<0.01).In the two groups of children,the BIND scores of ABE children with 6 and 12 h phototherapy were lower than those in the control group(P<0.05).The proportion of abnormal brainstem auditory evoked potential(BAEP)in children with ABE in the control group was higher than that in the emergency group after 2 to 3 months post-birth(P<0.05).There was no statistically significant difference in the proportion of abnormalities between the two groups in MRI(P>0.05).Conclusion:Modified"crash-cart"could quickly reduce serum TSB in children with severe hyperbilirubinemia,especially for critical hyperbilirubinemia,which could reduce the reqirement for transfusion therapy.It had a better prevention and treatment effect on mild to moderate ABE.