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目的比较两种治疗新生儿重度非溶血性高胆红素血症的效果,为临床选择治疗方法提供依据。方法回顾性分析2007年1月至2010年12月在新生儿病房住院的51例血总胆红素>342μmol/L的足月重度非溶血性高胆红素血症患儿,所有患儿均采用48h持续蓝光治疗,其中27例联合输注白蛋白治疗(A组),24例联合换血治疗(B组)。光疗开始后6、12、24、48h检测静脉血总胆红素,对血清总胆红素下降程度及住院时间、脑干听觉诱发电位等结果进行比较,评价两种治疗方法疗效的差异。结果 2组患儿血清总胆红素经治疗均有明显下降,治疗后6、12、24h胆红素下降差值B组大于A组(P均<0.01),但治疗48h后2组总胆红素下降差值差异无统计学意义(P>0.05)。2组各有3例患儿出现听力损伤,3个月后复查结果均无明显改善。B组与A组听力减退发生率(12.5%vs11.1%)及住院时间〔(9.1±2.1)vs(9.9±2.8)d〕比较差异均无统计学意义(P>0.05)。结论对新生儿非溶血性高胆红素血症,持续蓝光照射联合换血疗法仍为首选方法,但总的疗效与持续蓝光照射联合白蛋白输注疗法相当,在无换血条件的基层医院亦可采用持续蓝光照射联合白蛋白输注方法。
Objective To compare the effects of two treatments on severe non-hemolytic hyperbilirubinemia in newborns, and to provide basis for clinical choice of treatment. Methods A total of 51 children with full-term severe nonhemolytic hyperbilirubinemia with total bilirubin> 342μmol / L hospitalized in neonatal ward from January 2007 to December 2010 were retrospectively analyzed. All children Continued treatment with blue light 48h, including 27 cases of combined albumin infusion therapy (A group), 24 cases of combined transfusions (B group). Venous blood total bilirubin was detected at 6, 12, 24, and 48 hours after the start of phototherapy. The decrease of serum total bilirubin, hospitalization time and auditory evoked potential of brainstem were compared to evaluate the differences of curative effect between the two treatments. Results Serum total bilirubin was significantly decreased in both groups after treatment, and the difference between the two groups was greater at 6, 12, and 24 hours (P <0.01). However, after 48 hours of treatment, There was no significant difference in the difference of descending of red pigment (P> 0.05). Hearing impairment occurred in 3 of 2 patients in each group, and no significant improvement was found after 3 months. The incidence of hearing loss in group B and group A was significantly lower than that in group A (12.5% vs11.1%) and hospital stay (9.1 ± 2.1 vs 9.9 ± 2.8 d) (P> 0.05). Conclusion Neonatal non-hemolytic hyperbilirubinemia, continuous blue light irradiation combined with transfusion therapy is still the preferred method, but the overall effect and sustained blue light irradiation combined with albumin infusion therapy in the absence of transfusion of grass-roots hospitals may also be Continuous blue light irradiation and albumin infusion were used.