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目的总结我科近年新生儿Rh溶血病(Rh-HDN)的诊疗经验。方法选择2009—2010年本院新生儿中心收治的Rh-HDN患儿进行回顾性分析。患儿住院期间接受光疗、白蛋白静脉点滴及静脉注射大剂量丙种球蛋白(IVIG)治疗,重症给予换血或输血治疗,同时进行血红蛋白(Hb)、网织红细胞(Ret)和血清总胆红素(STB)等监测,观察疾病转归。结果重症组12例,入院时STB(449±128)μmol/L,治疗(12.4±2.8)h后,至换血前STB降至(309±89)μmol/L,与治疗前比较差异有统计学意义(P=0.001),其中11例行换血治疗;轻症组17例,入院时STB(243±91)μmol/L,治疗(14.5±3.9)h后STB下降至(205±62)μmol/L,与治疗前比较差异有统计学意义(P=0.032)。18例合并贫血,Hb低值平均(99.6±17.2)g/L,最低76.0g/L,10例给予输血治疗。除2例放弃治疗外,另27例患儿均治疗顺利,平均黄疸消退时间(10.8±3.4)天,平均住院时间(12.2±2.9)天。结论加强对Rh-HDN的认识,及早诊治,可避免胆红素脑病的发生,并可减少换血。
Objective To summarize the experience of diagnosis and treatment of Rh-HDN in our department in recent years. Methods A retrospective analysis was performed on children with Rh-HDN admitted to our neonatal center from 2009 to 2010. During hospitalization, children underwent phototherapy, albumin intravenous infusion and intravenous injection of high-dose gamma globulin (IVIG). Severe treatment was given to transfusion or blood transfusion. Hb, Ret and serum total bilirubin (STB) and other monitoring, observation of disease outcome. Results In the severe group, STB was lower than that before admission (STB 449 ± 128 μmol / L) after treatment (12.4 ± 2.8) h, and the STB before blood exchange was decreased to (309 ± 89) μmol / L, (P <0.001). Among them, 11 patients underwent transfusions. In the mild group, STB decreased to (205 ± 62) μmol / L after STL (243 ± 91) μmol / L, which was significantly different from that before treatment (P = 0.032). 18 patients with anemia, low mean Hb (99.6 ± 17.2) g / L, the lowest 76.0g / L, 10 patients were given transfusion therapy. Except for 2 cases giving up treatment, the other 27 cases were successfully treated. The mean jaundice subsided time was 10.8 ± 3.4 days and the average hospital stay was 12.2 ± 2.9 days. CONCLUSIONS: To strengthen the understanding of Rh-HDN and to diagnose and treat Rh-HDN early, it can avoid the occurrence of bilirubin encephalopathy and reduce transfusion.