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目的探讨选择应用丙种球蛋白治疗新生儿ABO溶血病的适宜胆红素阈值。方法将我院新生儿科2011年7月至2012年9月收治的新生儿ABO溶血病患儿随机分为两组,试验1组患儿胆红素值达到Bhutani曲线第75百分位、试验2组达到第95百分位时,应用1次丙种球蛋白1g/kg。比较两组患儿总光疗时间、治疗2天后胆红素下降幅度、住院时间、住院费用、血红蛋白值、应用丙种球蛋白的比例等资料。结果试验1组(66例)和试验2组(63例)患儿总光疗时间、胆红素下降幅度、住院时间、住院费用、生后42天血红蛋白值差异均无统计学意义(P>0.05),试验2组应用丙种球蛋白比例(34/63)小于试验1组(53/66),差异有统计学意义(P<0.01),两组均没有需要换血或发生胆红素脑病的病例。结论以Bhutani曲线第95百分位水平胆红素值作为应用丙种球蛋白治疗新生儿ABO溶血病的胆红素阈值更为合理。
Objective To investigate the suitable bilirubin threshold for the treatment of neonatal ABO hemolytic disease by using gamma globulin. Methods The neonates with neonatal ABO hemolytic disease admitted from July 2011 to September 2012 in our hospital were randomly divided into two groups. The bilirubin value of group 1 reached the 75th percentile of Bhutani curve. In experiment 2 Group reached the 95th percentile, the application of 1 g globulin 1g / kg. The total phototherapy time was compared between the two groups. After 2 days of treatment, the decrease of bilirubin, length of stay, cost of hospitalization, hemoglobin value and the proportion of gamma globulin were compared. Results There was no significant difference in total phototherapy time, bilirubin decline rate, hospitalization time, hospitalization cost and hemoglobin value 42 days after birth in trial group 1 (66 cases) and trial group 2 (63 cases) (P> 0.05 ). The proportion of gamma globulin (34/63) in trial 2 was less than that in trial 1 (53/66) (P <0.01). There were no cases of transfusion or bilirubin encephalopathy in both groups . Conclusion It is reasonable to use the 95th percentile bilirubin value of Bhutani curve as the bilirubin threshold for the treatment of neonatal ABO hemolytic disease with gamma globulin.