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Received:March 16, 2022 Published Online:January 20, 2023
Received:March 16, 2022 Published Online:January 20, 2023
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）
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