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目的总结“溶血危象”的相关特征,探讨溶血危象的诊断要点。方法对1999年3月至2006年3月入住深圳市人民医院儿科的83例AHA患儿临床资料进行回顾分析,根据以往有关溶血危象的概念中所涉及的各种表现在不同程度AHA的发生情况,对相关实验室检查结果进行评价。结果乏力、苍白、气促、呕吐、酱油色尿、心脏Ⅲ级以上收缩期吹风样杂音及肾功能异常等表现主要见于Hb≤70g/L的患儿,并随溶血程度加重而增多;WBC、BUN和LDH升高也以Hb≤70g/L的患儿改变较为明显,溶血越严重,WBC和LDH升高越明显;血钾、CO2结合力、GPT、网织红细胞计数在不同程度AHA的患儿中差异无显著性意义(P>0.05)。结论溶血危象的诊断要点:(1)确定为AHA。(2)Hb下降至≤70g/L,同时出现面色苍白、呕吐、酱油色尿、气促、心脏Ⅲ级以上收缩期吹风性的杂音和肾功能异常中5种以上的表现时应高度疑诊为溶血危象。(3)如伴有高热、腹痛、血压下降、意识障碍、惊厥、心力衰竭或急性肾功能衰竭表现之一者即可确诊。(4)Hb下降至30g/L以下的极重度AHA,无论患者的表现如何,均可诊断为溶血危象。(5)外周血WBC≥20×109/L和血清LDH≥850U/L有助于溶血危象的诊断。
Objective To summarize the related features of hemolysis crisis and explore the diagnostic points of hemolysis crisis. Methods The clinical data of 83 AHA children admitted to Shenzhen People’s Hospital from March 1999 to March 2006 were retrospectively analyzed. Based on the previous findings on the concept of hemolytic crisis, the occurrence of AHA in varying degrees The situation, the relevant laboratory test results were evaluated. The results of fatigue, pale, shortness of breath, vomiting, soy sauce color urine, heart rate above grade Ⅲ systolic hair-like murmur and renal dysfunction were mainly seen in children with Hb≤70g / L, and increased with the degree of hemolysis; WBC, The changes of BUN and LDH were also more obvious in children with Hb≤70g / L, the more severe hemolysis and the more obvious increase of WBC and LDH. The serum potassium, CO2 binding, GPT and reticulocyte count were significantly different in patients with AHA No significant difference between children (P> 0.05). Conclusion The diagnosis of hemolysis crisis points: (1) identified as AHA. (2) Hb decreased to ≤70g / L, while pale, vomiting, soy sauce color, shortness of breath, heart rate above grade Ⅲ systolic hair blowing noise and renal dysfunction, more than 5 kinds of performance should be highly suspected Hemolysis crisis. (3) As with high fever, abdominal pain, blood pressure, disturbance of consciousness, convulsions, heart failure or acute renal failure performance can be confirmed. (4) Very severe AHA with Hb falling below 30 g / L can be diagnosed as hemolysis crisis regardless of patient’s performance. (5) peripheral blood WBC≥20 × 109 / L and serum LDH≥850U / L contribute to the diagnosis of hemolysis crisis.