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目的探讨新生儿溶血病的早期诊断方法和治疗效果。方法凡查出孕妇血型为O或Rh阴性,并与丈夫血型不合,且抗A(或B)效价>1∶64,或抗Rh效价>1∶8,分娩时常规留取脐静脉血3ml,送验血型和溶血三项试验,确诊为母婴血型不合溶血病的不等黄疸出现,立即开始治疗,作为早治组。孕妇未作血型检查,其新生儿出现病理性黄疸后才确诊为新生儿溶血病而开始治疗的为对照组。比较两组新生儿黄疸持续时间、高峰期胆红素值、出生体重、胎龄以及换血例数、胆红素脑病发生例数等。结果十年间共诊断新生儿溶血病46例,其中早治组28例(ABO溶血病26例,Rh溶血病2例),对照组18例(ABO溶血病16例,Rh溶血病2例)。黄疸持续时间,早治组显著短于对照组(P<001)。高峰期胆红素值,两组比较差异无显著意义(P>005)。出生体重、胎龄,两组比较差异无显著意义(P>005)。对照组2例Rh溶血病均经换血治疗,1例发生胆红素脑病。早治组全部治愈,未经换血,无胆红素脑病发生。结论利用脐血检验能早期诊断新生儿溶血病;在黄疸出现前确诊并开始治疗,能显著缩短黄疸持续时间,减少换血治疗,防止胆红素脑病。
Objective To explore the early diagnosis and treatment of neonatal hemolytic disease. Method Where pregnant women were found to be O or Rh negative blood group, and her husband’s blood group incompatibility, and anti-A (or B) titer> 1:64, or anti-Rh potency> 1: 8, umbilical venous routine 3ml, blood test and hemolytic sent three tests, diagnosed as maternal and child blood incompatible hemolytic jaundice appeared, immediately began treatment, as an early treatment group. Pregnant women did not make blood type examination, the neonatal pathological jaundice was diagnosed as neonatal hemolytic disease and began treatment for the control group. The duration of neonatal jaundice, peak bilirubin, birth weight, gestational age, blood transfusion and bilirubin encephalopathy were compared between the two groups. Results A total of 46 cases of hemolytic disease were diagnosed in 10 years. Among them, 28 cases in early treatment group (ABO hemolytic disease in 26 cases and Rh hemolytic disease in 2 cases), and 18 cases in control group (ABO hemolytic disease in 16 cases and Rh hemolytic disease in 2 cases). Jaundice duration, early treatment group was significantly shorter than the control group (P <001). Peak bilirubin value, no significant difference between the two groups (P> 005). Birth weight, gestational age, no significant difference between the two groups (P> 005). In the control group, 2 cases of Rh hemolytic disease were treated by transfusions and 1 case of bilirubin encephalopathy. Early treatment group were all cured, without exchange of blood, no bilirubin encephalopathy. Conclusion Umbilical cord blood tests can be used to diagnose neonatal hemolytic disease early. Diagnosis and treatment before jaundice can significantly reduce the duration of jaundice, reduce transfusion and prevent bilirubin encephalopathy.