黄疸及新生儿黄疸的诊断与治疗.ppt

换血疗法--指征 确诊溶血病，出生时脐血Hb＜120/L， 伴水肿、肝脾大、心衰 血清胆红素重度升高 有早期核黄疸症状者，不论胆红素高低 早产儿前一胎病情严重者，放宽指征 药物疗法 （一）酶诱导剂 苯巴比妥 尼可刹米 （二）减少游离胆红素 白蛋白：1g/kg， 或血浆，25ml/次，可给1～2次。 （三）抑制溶血 静脉用丙种球蛋白：阻断Fc受体来抑制溶血，1g/kg，6～8小时内持续静滴。 谢 谢 * 教学提示：这次课的教学对象是医学检验专业5年制本科。 我们这次课的主要内容包括以下四个方面： 1. Rh新生儿溶血病的基本概念 2. Rh新生儿溶血病的发病机制 3. Rh新生儿溶血病的临床表现 4. Rh新生儿溶血病的实验室检查 Rh新生儿溶血病的发病机制：是我们这次课教学的难点； Rh新生儿溶血病的实验室检查：是我们这次课教学的重点。 对难点内容发病机制的理解是我们掌握Rh新生儿溶血病的实验室检查的基础。 * * * * * * * In 95% of neonates and 3–5% of adults, acute HBV infection does not clear spontaneously and chronic infection can persist for years.1 Over time,10–30% of chronically infected patients develop necro-inflammatory liver disease (‘chronic hepatitis’), which typically leads to more marked symptoms and the histological changes known as cirrhosis. Further disease progression may lead to severe late-stage complications such as ascites, liver failure and death. A significant proportion of individuals with HBsAg eventually develop HCC; they have a 100-fold increased risk of HCC relative to those without HBsAg.2 Chronic HBV infection resulting from perinatal transmission represents a greater risk for HCC than infection acquired as an adult. Up to 40% of HBV infections acquired neonatally eventually develop HCC.2 The highest incidence of HCC is in patients with chronic inflammation and cirrhosis, and it typically occurs only after 25–30 years of infection.1 References 1. Lee WM. Hepatitis B virus infection. N Engl J Med 1997; 337: 1733–45. 2. Chu C-M. Towards control of hepatitis B in the Asia-Pacific region: natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular cancer. J Gastroenterol Hepatol 2000; 15 (Suppl.): E25–30. 3. Feitelson MA. Biology of disease: biology of hepatitis B virus mutants. Lab Invest 1994; 71: 324–49. * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * 为什么亦可发生于第一胎？ 1.输血；2.外祖母学说。 * In 95% of neonates and 3–5% of adults, acute HBV infection