新生儿高胆红素血症换血治疗在降低脑干听觉诱发电位异常率的意义

摘要

[Objective]To explore the significance of exchange transfusion therapy in neonatal hyperbilirubinemia.[Methods]Totally 588 hospitalized patients for neonatal hyperbilirubinemia without obvious symptoms and signs of bilirubin encephalopathy on admission were enrolled from November 2008 to October 2009.Among all patients, 311 patients who received exchange transfusion therapy were selected as observation group, and 277 patients who did not receive exchange transfusion therapy were selected as control group.Brain injury and hearing impairment caused by other reasons in all pediatric patients were excluded.The change of serum bilirubin level and abnormal rate of brain stem auditory evoked potentials(BAEP) of patients in two groups were analyzed retrospectively.[Results]With the increased level of serum bilirubin, the abnorreal rate of BAEP elevated, and the difference was statistically significant.The decreased level and clearance rate of serum bilirubin in observation group were better than those in control group, and the difference was also statistically significant.In pediatric patients aged from 72 hours to 168 hours, the abnormal rate of BAEP in all levels of serum bilirubin in observation group was lower than that in control group, and the difference was statistically significant( P ＜0.05).In pediatric patients aged over 168 hours, there was no significant difference in the abnormal rate of BAEP in all levels of serum bilirubin between the observation group and control group( P ＞0.05).[Conclusion]Early severe neonatal hyperbilirubinemia should accept exchange transfusion therapy actively if serum bilirubin level conforms to the standard of exchange transfusion.It can reduce the possibility of hearing impairment.The function of blood brain barrier is relatively mature, so whether exchange transfusion can reduce the incidence of hearing impairment or alleviate the degree of the injury needs further follow-up observation and prospective studies.%[目的]探讨新生儿高间接胆红素血症脑干听觉诱发电位(BAEP)异常率及换血治疗的意义.[方法]以2008年11月至2009年10月入住本院的新生儿高间接胆红素血症,且入院时没有明显的胆红素脑病症状和体征、资料完整的588例,其中311例接受了换血治疗为观察组,未接受换血治疗277例为对照组.所有患儿均排除因其他原因导致的脑损伤和听力损伤.检测分析两组患儿血清胆红素水平变化以及BAEP的异常率.[结果]随着血清胆红素水平的增高BAEP异常率呈上升趋势,差异有统计学意义(P<0.01);观察组血清总胆红素(sTB)水平下降幅度及清除率均优于对照组,差异有统计学意义(P<0.01);在～72 h和～168 h年龄段患儿中,各胆红素水平段观察组BAEP异常率低于对照组,差异有统计学意义(P＜0.05),而＞168 h年龄段患儿中,各胆红素水平段观察组与对照组的BAEP异常率差异没有统计学意义(P＞0.05).[结论]早期新生儿重度高间接胆红素血症患儿胆红素水平达到换血水平时应积极进行换血治疗,可减少听力损伤的可能,而晚期新生儿因血脑屏障功能相对较完善,换血能否减少听力损伤的发生或减轻损伤的程度有待进一步随访和前瞻性研究.