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1 病例介绍 患儿,女,11h。生后8h颜面部出现黄染,3h内迅速波及全身,伴精神差,哭声弱小,无发烧及抽搐,未排胎便。患儿系第3胎第1产,足月自然分娩,生后无窒息,第1胎、第2胎分别于1年前人工流产。查体:神志清,反应差,全身皮肤粘膜呈金黄色,无出血点,淋巴结无肿大。前囟平软,眼结膜苍白,巩膜黄染。呼吸稍促,双肺听诊无异常,心率150次/分,心音有力,心前区闻及Ⅱ级收缩期杂音,柔和,不传导。腹软, 肝剑下、右肋下各4cm,脾左肋下3.5cm,质韧。双下肢无水肿,肌张力低下,拥抱反射未引出。入院时急查血总胆红素326.6μmol/L,直接胆红素138.5μmol/L,Hb 97g/L,RBC 2.41×10~（12）/L,网织红细胞0.208,WBC 12.6×10~9/L。有核RBC 133:100,患儿及其母均为A型Rh阳性血。患儿直接coombs试验++,抗体筛选试验:抗E阳性。母血抗E效价1:32,急给白蛋白1g/kg·次静滴,氟美松2mg静推,双面蓝光照射,同时准备换血。患儿入院后
1 case description Children, female, 11h. 8h after birth, facial yellowish yellow dye, quickly spread to the body within 3h, with poor spirit, weak crying, no fever and convulsions, no placenta. Children with the third birth of the first line of production, full-term natural childbirth, after birth, no asphyxia, the first child, the second child were induced abortion 1 year ago. Examination: Consciousness, poor response, systemic skin mucosa was golden yellow, no bleeding, no swelling of the lymph nodes. Anterior fontanelle soft, pale conjunctiva, sclera yellow dye. Breathing a little, no abnormal lung auscultation, heart rate 150 beats / min, strong heart sounds, precordial area smell and Ⅱ systolic murmur, soft, not conductive. Abdominal soft, liver sword, the right rib 4cm, spleen left rib 3.5cm, quality tough. No lower extremity edema, low muscle tone, embrace the reflection did not lead. On admission, the blood total bilirubin 326.6μmol / L, direct bilirubin 138.5μmol / L, Hb 97g / L, RBC 2.41 × 10-12 / L, reticulocyte 0.208, WBC 12.6 × 10-9 / L. Nucleated RBC 133: 100, children and their mothers are type A Rh-positive blood. Children direct coombs test ++, antibody screening test: anti-E positive. Maternal anti-E titer 1:32, acute albumin 1g / kg · intravenous infusion, 2mg dexamethasone push, double-sided blue light irradiation, while preparing for blood transfusion. Children after admission