吴丹,张晓梅,张文娟,陈俊龙,刘燕,蒋国雄
WU Dan,ZHANG Xiaomei,ZHANG Wenjuan,CHEN Junlong,LIU Yan,JIANG Guoxiong

• 1:内蒙古自治区人民医院新生儿科

摘要(Abstract)：

目的 观察换血疗法对胆红素脑病患儿神经行为发育的影响。方法 新生儿科收治的胆红素脑病(警告期)患儿86例，随机数字法均分为对照组和观察组，对照组采用蓝光照射常规治疗，观察组采用外周动静脉同步换血疗法; CM800-全自动生化分析仪检测两组患儿干预前、干预后24 h时血清中总胆红素(TBIL)、间接胆红素(IBIL)、结合胆红素(DBIL)及血浆白蛋白，计算胆红素/血浆白蛋白比值(B/A);全身运动质量评估量表(GMs)评估两组患儿干预前、干预后12个月时的全身运动情况;婴儿运动能力测试量表(TIMP)评估两组患儿干预前、干预后24 h时运动能力;采用Gesell婴幼儿发育检查量评估干预前、干预后12个月时两组患儿神经行为发育情况;采用52项神经运动发育量表评估两组患儿干预前、干预后12个月时的神经运动发育情况;记录两组患儿治疗期间出现的不良反应。结果 干预后24 h时，两组胆红素脑病(警告期患儿TBIL、IBIL、DBIL及B/A表达较干预前均降低、且观察组低于对照组，差异有统计学意义(P <0.05);干预后24 h时，观察组扭动运动阶段及不安运动阶段的人数均高于对照组，差异有统计学意义(P <0.05);干预后24 h时，两组TIMP评分均较干预前升高、且观察组高于对照组，差异有统计学意义(P <0.05);干预后12个月时，观察组Gesell评分中大运动、精细动作、适应能力、语言及交往评分均高于对照组，差异有统计学意义(P <0.05);与干预前比较，干预后12个月时两组52项神经运动发育正常的人数增加、异常发育异常的人数减少，且观察组正常人数高于对照组(P <0.05);两组不良反应比较，差异无统计学意义(P> 0.05)。结论 换血疗法能够通过降低胆红素脑病患儿血清胆红素水平，改善患儿运动能力及神经行为发育能力。
Objective To observe the effects of blood exchange therapy on the neurobehavioral development of patients with bilirubin encephalopathy.Methods A total of 86 children with bilirubin encephalopathy (in the warning stage) treated in the department of neonatology were divided into the control group and the study group by random number method.The control group received routine treatment with blue light irradiation,and the study group received peripheral arteriovenous synchronous blood exchange therapy.CM800 automatic biochemical analyzer was used to measure the total bilirubin(TBIL),indirect bilirubin (IBIL),conjugated bilirubin (DBIL),and plasma albumin in the serum of the two groups before and 24 hours after intervention.The bilirubin/plasma albumin ratio (B/A)was calculated;Gesell Developmental Scale was used to evaluate the neurobehavioral development of both groups before and 12 months after intervention and General Movements (GMs) was used to evaluate the exercise of the two groups before and 12 months after intervention.The infant motor ability test (TIMP) was used to evaluate the motor ability of the two groups before and 24 hours after intervention;52 items of neurobehavioral assessment were used to assess the neurobehavioral functions of both groups before and 12 months after intervention.During the treatment,the adverse reactions of the two groups were recorded.Results There was no significant difference in the expression of TBIL,IBIL,DBIL,and B/A before intervention (P>0.05).The above levels in the two groups decreased24 hours after intervention,and there was a significant difference between the exchange transfusion group and the conventional group (P<0.05).Before intervention,there was no statistically significant difference between the two groups in terms of GMs scores in the wriggle stage and the restless stage (P>0.05).In the 12thmonth after intervention,the number of children in the exchange transfusion group in the wriggle stage and the restless stage was higher than that in the conventional group,and the difference was statistically significant (P<0.05).Before intervention,there was no significant difference in TIMP scores between the two groups (P>0.05);24 hours after intervention,the TIMP scores of the conventional group and exchange transfusion group increased,and the TIMP score of the exchange transfusion group was significantly higher than that of the conventional group,with a statistically significant difference (P<0.05);before intervention,there was no statistically significant difference between the two groups in Gesell scores of large movement,fine movement,adaptability,language and communication (P>0.05).Twelve months after intervention,Gesell scores of the exchange transfusion group were higher than those of the conventional group in large movement,fine movement,adaptability,language and communication,with statistically significant differences between the groups (P<0.05);before intervention,there was no significant difference in52 neurobehavioral items between the two groups (P>0.05);in the 12thmonth after intervention,the normal condition of 52 neurobehaviors of the two groups increased,and the abnormal condition decreased.The normal condition of 52 neurobehaviors of the exchange transfusion group was significantly higher than that in the conventional group (P<0.05).There was no significant difference in adverse reactions between the two groups (P>0.05).Conclusion Blood exchange therapy can improve the neurobehavioral function by reducing the level of serum bilirubin in children with bilirubin encephalopathy.It is safe and worthy of application.

关键词(KeyWords)： 胆红素脑病;新生儿;换血疗法;神经行为发育;全身运动;不良反应
bilirubin encephalopathy;newborn;blood exchange therapy;neurobehavioral development;general movements;adverse reactions

Abstract:

Keywords:

基金项目(Foundation): 内蒙古自治区自然科学基金项目(2020MS08204);; 2022年度自治区卫生健康科技计划项目(202202040)

作者(Author): 吴丹,张晓梅,张文娟,陈俊龙,刘燕,蒋国雄
WU Dan,ZHANG Xiaomei,ZHANG Wenjuan,CHEN Junlong,LIU Yan,JIANG Guoxiong

DOI: 10.19367/j.cnki.2096-8388.2023.02.013

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