胆道闭锁葛西术后儿童的预防接种观察与分析

Analysis on vaccination of children with biliary atresia after Kasai surgery

目的 探讨胆道闭锁葛西术后儿童预防接种的现状。方法 回顾2019—2022年本院诊断胆道闭锁行葛西手术治疗的70例儿童(年龄:11月~3岁4个月;男性:37例,女33例)临床资料,分析临床特征、疫苗接种资料及不良反应发生情况。根据是否评估进行分组,比较两组肝功能指标和疫苗接种率。结果 70例儿童葛西术前(除出生时接种疫苗外)、术后接种疫苗比例分别为11.4%、72.8%。葛西术后6月起恢复免疫接种占86.3%;恢复免疫接种时转氨酶升高占78.4%,胆汁酸异常为82.4%,56.9%服用药物。所有儿童在接种后均未出现严重的不良反应。手术时间在2019年12月~2020年12月与2021年1月~2022年6月比较,经特需人群接种门诊临床医生评估后,葛西术后儿童疫苗接种率明显提高(46.7%vs. 92.5%,P<0.05)。结论 在预防接种工作中,胆道闭锁葛西术后儿童疫苗接种率低,接种延迟明显,经评估病情稳定,及时进行预防接种是安全的,也是非常必要的。

Objective To investigate the status of vaccination in children with biliary atresia after Kasai surgery.Methods A retrospective study was conducted among 70 children diagnosed with biliary atresia and underwent Kasai surgery aged from 11 months to 3 years and 4 months in 2019-2022.There were 37 male cases and 33 female cases.Clinical characteristics,vaccination status and adverse reactions were analyzed.Children were grouped according to whether they were evaluated,and the liver function indicators and vaccination rates were compared between two groups.Results Among 70 cases,the vaccination rates with Kasai preoperatively(excluding vaccination at birth)and postoperatively were 11.4%and 72.8%respectively.86.3%of patients resumed vaccination after 6 months postoperatively.78.4%of children after Kasai surgery had elevated transaminases when they resumed immunization.82.4%of them had abnormal bile acids,and 56.9%of patients took drugs when the vaccination was resumed.None of children had serious adverse reactions after vaccination.After being evaluated by clinicians in special vaccination clinic(operation time from December 2019 to December 2020 vs.January 2021 to June 2022),the vaccination rate of children after Kasai surgery increased significantly[46.7%vs.92.5%,P<0.05].Conclusion Our study revealed that the vaccination rate of children with biliary atresia after surgery is low,and the vaccination delay is significant.Timely vaccination should be safe and necessary when the condition is stable,after evaluation for those children.