摘要
目的 探讨枯草杆菌二联活菌颗粒联合静注人免疫球蛋白在治疗新生儿ABO溶血性黄疸中的临床应用价值.方法 前瞻性纳入2021年1月至2023年6月安徽医科大学附属安庆第一人民医院收治的82例新生儿ABO溶血性黄疸作为观察对象,根据随机数字表法分为观察组和对照组,每组各41例.给予对照组人免疫球蛋白注射治疗联合光疗,观察组在对照组基础上联合应用枯草杆菌二联活菌颗粒.观察两组治疗效果,比较两组患儿的临床指标(黄疸消退时间、首次排胎粪时间、胎粪排净时间及住院时间),并比较两组患儿治疗前、治疗5 d后的实验室指标(血清总胆红素、间接胆红素和红细胞计数、血红蛋白)和肝功能指标[天冬氨酸转移酶(AST)、丙氨酸转移酶(ALT)、碱性磷酸酶(ALP)]水平,观察两组患儿的不良反应发生情况.结果 观察组总有效率为85.37％,显著高于对照组(65.85％),差异有统计学意义(P＜0.05).观察组患儿黄疸消退时间、首次排胎粪时间、胎粪排净时间及住院时间均较对照组明显缩短,差异均有统计学意义(P＜0.05).治疗5 d后,观察组总胆红素、间接胆红素分别为(114.54±25.22)、(101.52± 22.31)μmol/L,均低于对照组[(132.49±39.42)、(125.23±40.29)μmol/L],观察组红细胞计数和血红蛋白水平分别为(4.29±0.42)×1012/L、(153.32±13.32)g/L,均高于对照组[(3.54±0.45)×1012/L、(145.21±14.29)g/L],差异均有统计学意义(P＜0.05).治疗5d后,观察组的AST、ALT和ALP水平分别为(34.23±5.21)、(45.21±6.43)、(138.05±20.04)U/L,均低于对照组[(45.03±6.04)、(103.42±15.62)、(174.52±28.51)U/L],差异均有统计学意义(P＜0.05).观察组总不良反应发生率为4.88％,低于对照组(26.83％),差异有统计学意义(P＜0.05).结论 在人免疫球蛋白的基础上联合枯草杆菌二联活菌颗粒治疗提高ABO溶血性黄疸患儿疗效,可有效缩短患儿的康复进程,并改善其肝功能水平,且不良反应较少,值得推广.
Abstract
Objective To explore the clinical application value of Bacillus subtilis combined with human immunoglobulin in the treatment of neonatal ABO hemolytic jaundice.Methods Eighty-two cases of neonatal ABO hemolytic jaundice admitted in Anqing First People's Hospital of Anhui Medical University from January 2021 to June 2023 were included as the observation objects,and were divided into the observation group and the control group according to the random number table method,with 41 cases in each group.The control group was given human immunoglob-ulin injection combined with phototherapy,and the observation group was given Bacillus subtilis combined with live bacteria granules on the basis of the control group.The therapeutic effects of the two groups were observed,and the clinical indicators(jaundice resolution time,first meconium excretion time,meconium clearance time,and hospital stay)of two groups of children were compared.The laboratory indicators(serum total bili-rubin,indirect bilirubin and red blood cell count,hemoglobin)and liver function indicators[aspartate aminotransferase(AST),alanine transfer-ase(ALT),alkaline phosphatase(ALP)]levels were compared between two groups of children before and after 5 days of treatment,the occur-rence of adverse reactions in two groups of children was observed.Results The total effective rate of the observation group was 85.37％,which was significantly higher than that of the control group(65.85％),and the difference was statistically significant(P＜0.05).The jaundice reso-lution time,first meconium excretion time,meconium clearance time,and hospitalization time of the observation group were significantly shortened compared to those of the control group,and the differences were statistically significant(P＜0.05).After 5 days of treatment,the levels of total bilirubin and indirect bilirubin in the observation group were(114.54±25.22)and(101.52±22.31)μmol/L,respectively,which were lower than those in the control group[(132.49±39.42),(125.23±40.29)]μmol/L],the levels of red blood cell count and hemoglobin were(4.29±0.42)x 1012/L and(153.32±13.32)g/L,respectively,which were higher than those in the control group[(3.54±0.45)x 1012/L and(145.21±14.29)g/L],and the differences were statistically significant(P＜0.05).After 5 days of treatment,the levels of AST,ALT,and ALP in the observation group were(34.23±5.21),(45.21±6.43),and(138.05±20.04)U/L,respectively,which were lower than those in the control group[(45.03±6.04),(103.42±15.62),and(174.52±28.51)U/L],and the differences were statistically sig-nificant(P＜0.05).The total incidence of adverse reactions in the observation group was 4.88％,which was lower than that in the control group(26.83％),and the difference was statistically significant(P＜0.05).Conclusion The treatment based on human immunoglobulin combined with live bacteria secondary to Agrobacterium can improve the therapeutic effect of children with ABO hemolytic jaundice,effectively shorten the rehabilitation process,improve the level of liver function and serum factors,and has few adverse reactions,which is worth popularizing.
维普
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