新生儿急性胆红素脑病76例临床分析
摘要
目的探讨新生儿急性胆红素脑病的早期临床诊治经验。方法回顾性分析76例急性胆红素脑病的新生患儿的病例资料。入院时血清胆红素(TSB)为(466.53±87.24)μmol/L,根据急性期临床表现分为无症状组25例,有症状组51例,根据ABE评分表,有症状组分为轻度33例,中度14例,重度4例。所有患儿入院均加强光疗,其中有50例进行换血治疗。结果无症状组头颅MRI检查异常率为100%,死亡-不良转归率20%。有症状组51例,随ABE程度加重,TSB和血浆白蛋白比值(B/A值)明显增高,BAEP异常率、MRI异常率和死亡-不良转归发生率均明显上升(P<0.05)。结论 ABE的临床量化评分及监测TSB、B/A值、BAEP、MRI是早期诊断新生儿胆红素脑病的重要方法;对无症状的严重胆红素血症患儿早期行头颅MRI检查,有利于对胆红素脑病高危儿进行早期评估、医学干预并改善预后。
引文
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[13]吕峻峰,杨冰岩,王维琼,等.严重高胆红素血症新生儿急性胆红素脑病危险因素分析[J].中国新生儿科杂志,2014,29(4):242-244.
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[15]毛健,富建华,陈丽英,等.重度高胆红素血症新生儿苍白球磁共振成像特征及其临床意义[J].中华儿科杂志,2007,45(1):24-29.
[16]李豪刚,张玉忠,陈凯,等.MRI在新生儿胆红素脑病中诊断价值[J].放射学实践,2013,28(10):1062-1065.
[17]颜慧恒,任建兵,钟迪,等.广东省不同胎龄新生儿胆红素脑病多中心调查结果分析[J].国际医药卫生导报,2017,23(24):3826-3828.
[2]MANNING D,TODD P,MAXWELL M,et al.Prospective surveilance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland[J].Arch Dis Child Fetal Neonatal Ed,2007,92(5):F342-346.
[3]MAISELS M J,NEWMAN T B.Kernicterus in otherwise healthy,breast-fed term newborns[J].Pediatrics,1995,96(1):730-733.
[4]中华医学会儿科学分会新生儿学组,中国新生儿胆红素脑病研究协作组.中国新生儿胆红素脑病的多中心流行病学调查研究[J].中华儿科杂志,2012,50(5):331-335.
[5]JOHNSON L,BHUTANI V K,KARP K,et al.Clinical report from the pilot USA Kernicterus Registry(1992 to 2004)[J].JPerinatol,2009,29(Suppl 1):S25-S45.
[6]WU W,ZHANG P,WANG X,et al.Usefulness of 1H-MRS in differentiating bilirubin encephalopathy from severe hyperbilirubinemia in neonates[J].J Magn Reson Imaging,2013,38(3):634-640.
[7]GAMALELDIN R,ISKANDER I,SEOUD I,et al.Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia[J].Pediatrics,2011,128(4):e925-e931.
[8]刘开珍,何华云,华子瑜,等.新生儿急性胆红素脑病227例临床分析[J].临床儿科杂志,2012,30(9):840-844.
[9]OLUSANYA B O,OGUNLESI T A,KUMAR P,et al.Management of latepreterm and term infants with hyperbilirubinaemia in resourceconstrained settings[J].BMC Pediatr,2015,15(1):39.
[10]金汉珍,黄德珉,关希吉.实用新生儿学[M].3版.北京:人民卫生出版社,2002:297-305.
[11]魏幼华,王智楠,陈平,等.严重高胆红素血症新生儿的听力学特征[J].听力学及言语疾病杂志,2011,19(3):206-209.
[12]汪浩文,黄金保.新生儿高胆红素血症血清前白蛋白及总胆红素/白蛋白比值与脑干诱发电位的关系[J].国际儿科学杂志,2011,38(1):91-93.
[13]吕峻峰,杨冰岩,王维琼,等.严重高胆红素血症新生儿急性胆红素脑病危险因素分析[J].中国新生儿科杂志,2014,29(4):242-244.
[14]王艳丽,颜慧恒,张永,等.胆红素脑病患儿内在因素及外在高危因素分析[J].中国新生儿科杂志,2015,30(2):90-91.
[15]毛健,富建华,陈丽英,等.重度高胆红素血症新生儿苍白球磁共振成像特征及其临床意义[J].中华儿科杂志,2007,45(1):24-29.
[16]李豪刚,张玉忠,陈凯,等.MRI在新生儿胆红素脑病中诊断价值[J].放射学实践,2013,28(10):1062-1065.
[17]颜慧恒,任建兵,钟迪,等.广东省不同胎龄新生儿胆红素脑病多中心调查结果分析[J].国际医药卫生导报,2017,23(24):3826-3828.