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投稿时间:2022-03-16 网络发布日期:2023-01-20
投稿时间:2022-03-16 网络发布日期:2023-01-20
中文摘要: 目的探讨质量改进对新生儿ABO血型不合溶血病(ABO-HDN)伴重症高胆红素血症(HB)诊治的意义。
方法制定ABO-HDN管理质量改进方案,前瞻性选择2019年1月至2021年8月武汉科技大学附属孝感医院新生儿科收治ABO-HDN伴重症HB45例患儿为研究组,回顾性收集2016年1月至2018年12月收治ABO-HDN伴重症HB47例患儿为对照组。主要观察指标为ABO-HDN诊断时日龄、启动光照疗法时间、换血治疗率、急性胆红素脑病发生率。
结果与对照组比较,研究组孕母抗体滴度筛查率提高(91.1%vs70.2%),发现患儿黄疸的日龄提前[(18.8±12.4)hvs(32.3±18.4)h]、患儿入院日龄提前[(32.4±20.6)hvs(50.2±36.8)h]、ABO-HDN诊断时日龄提前[(35.8±24.3)hvs(52.6±38.2)h]、入院时总胆红素降低和血红蛋白升高,入院启动光疗时间提前[(10.0±5.2)minvs(30.0±7.1)min],差异均有统计学意义(P<0.01);研究组光照疗法时间、换血治疗发生率(0vs10.64%)、急性胆红素脑病发生率(4.44%vs6.38%)均较对照组有所降低,但差异无统计学意义(P>0.05)。
结论质量改进利于ABO-HDN早诊断及快速有效治疗,可以避免ABO-HDN伴重症HB的换血治疗,且不增加急性胆红素脑病发生。
中文关键词: 溶血病,ABO血型不合 新生儿 质量改进 诊断 换血治疗
Abstract:ObjectiveToexplorethesignificanceofqualityimprovementinthediagnosisandtreatmentofABOhemolyticdiseaseofnewborn(ABO-HDN)withseverehyperbilirubinemia(HB).
MethodsFourty-fivenewbornwithABO-HDNandsevereHBwereprospectivelyselectedasstudygroup,whowereadmittedtoXiaoganHospitalaffiliatedtoWuhanUniversityofScienceandTechnologyfromJanuary2019toAugust2021,forwhomABO-HDNmanagementqualityimprovementprogramwasformulatedandimplemented,and47newbornwiththesamediseasetreatedfromJanuary2016toDecember2018wereservedascontrolgroupforretrospectiveanalysis.Themainoutcomemeasuresweredayageatdiagnosis,timetostartlighttherapy,rateofbloodexchangetherapyandincidenceofacutebilirubinencephalopathy(ABE).
ResultsComparedwiththoseincontrolgroup,thescreeningrateofmaternalantibodytiterincreased(91.1%vs70.2%),thetimeofdiscoveryofneonataljaundice[(18.8±12.4)hvs(32.3±18.4)h],admissiontime[(32.4±20.6)hvs(50.2±36.8)h],ABO-HDNdiagnosistime[(35.8±24.3)hvs(52.6±38.2)h]andthetimeofinitiationofphototherapy[(10.0±5.2)minvs(30.0±7.1)min]wereearlier,theleveloftotalserumbilirubin(TSB)decreased,andthehemoglobinlevelincreasedatadmissioninstudygroup(P<0.01).Thetimeoflighttherapyandtheincidencesofbloodexchangetherapy(0vs10.64%)andABE(4.44%vs6.38%)instudygroupwerelowerthanthoseincontrolgroup,buttherewerenostatisticaldifferencesinthem(P>0.05).
ConclusionThequalityimprovementisbeneficialtotheearlydiagnosisandrapidandeffectivetreatmentofABO-HDN,canavoidexchangetransfusionwithoutincreasingtheoccurrenceofABEinthetreatmentofABO-HDNwithsevereHB.
keywords: Hemolyticdisease,ABOincompatibility Neonate Qualityimprovement Diagnosis Bloodexchangetherapy
文章编号: 中图分类号:R722.18 文献标志码:A
基金项目:湖北省卫生计生指导性项目(WJ2019F123)
Author Name | Affiliation |
WANGNai-yu*,YANGShu-jie,GANBin,HEYuan,ZHANGPing,YANGMeng,LILei | *JinzhouMedicalUniversity,Jinzhou,Liaoning121001,China |
引用文本:
王乃玉,杨树杰,甘斌,等.新生儿ABO血型不合溶血病伴重症高胆红素血症诊治的质量改进[J].中国临床研究,2023,36(1):55-59.
王乃玉,杨树杰,甘斌,等.新生儿ABO血型不合溶血病伴重症高胆红素血症诊治的质量改进[J].中国临床研究,2023,36(1):55-59.