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幼兒abo溶血癥怎么治療？需要注意些什么？

出處：網(wǎng)絡(luò)收集日期：2024-06-22 10:11:11編輯：秩名

abo溶血怎么治療？

abo溶血嚴(yán)重時(shí)可危害新生兒的生命安全，還可能會(huì)后續(xù)影響寶寶的健康，所以我們一定要了解清楚，abo溶血怎么治療？
 
分娩時(shí)，就要做好新生兒的搶救準(zhǔn)備：胎兒娩出立即斷臍，減少抗體進(jìn)入寶寶體內(nèi)；保留臍帶，以備嚴(yán)重溶血病患兒換血用。
 
新生兒出生后要嚴(yán)密觀察黃疸出現(xiàn)時(shí)間，一般第2~3天，嚴(yán)重者24小時(shí)內(nèi)就出現(xiàn)黃疸，并要注意黃疸加深速度，如膽紅素濃度過(guò)高，不及時(shí)處理可引起膽紅素腦病，以后影響智力，所以ABO溶血病要及早治療。具體措施如下：
 
1、光照療法
 
是降低血清膽紅素最簡(jiǎn)便而有效的方法。當(dāng)血清膽紅素達(dá)到光療標(biāo)準(zhǔn)時(shí)應(yīng)及時(shí)進(jìn)行光療。光療標(biāo)準(zhǔn)是依據(jù)不同胎齡、不同日齡有無(wú)并發(fā)癥而制定的不同光療標(biāo)準(zhǔn)。
 
它的優(yōu)點(diǎn)是退黃疸快，副作用少，皮膚黃疸接受光照后膽紅素可分解成水溶性，從腸道、尿中排出體外，從而降低血中膽紅素濃度，可避免膽紅素腦病的發(fā)生。光照療法時(shí)有的寶寶可出現(xiàn)一過(guò)敏性皮疹、大便次數(shù)增多等輕微的副作用，這些癥狀不需要處理，停光照后可自愈。
 
2、藥物治療
 
黃疸較嚴(yán)重者可反復(fù)多次光照療法，同時(shí)加用藥物治療。
 
（1）靜脈用丙種球蛋白 早期應(yīng)用臨床效果較好。
 
（2）白蛋白增加游離膽紅素的聯(lián)結(jié)，減少膽紅素腦病的發(fā)生。
 
3、補(bǔ)充鐵劑或輸血
 
絕大多數(shù)ABO溶血病的寶寶不需要換血，經(jīng)積極治療后預(yù)后良好。新生兒ABO溶血病常同時(shí)伴有貧血，其程度與溶血程度一致。輕度溶血者常貧血較輕，嚴(yán)重溶血病患兒可能有較重的貧血，可根據(jù)貧血程度給予補(bǔ)充鐵劑或輸血等相應(yīng)的治療。
 

abo溶血的原因

到底是什么原因?qū)е铝薬bo溶血這樣危害寶寶健康，甚至生命安全的病癥呢，相信了解清楚將會(huì)有利于我們后續(xù)的治療。
 
ABO血型的分類主要是按照紅細(xì)胞上有無(wú)A、B血型抗原來(lái)分的，即紅細(xì)胞上只有A抗原的稱為A型，紅細(xì)胞上只有B抗原的稱為B型，紅細(xì)胞上無(wú)A、B抗原的稱為O型，紅細(xì)胞上有A和B抗原的稱為AB型。嬰兒的遺傳物質(zhì)一半來(lái)自父親，一半來(lái)自母親，所以嬰兒有可能繼承媽媽的血型，也有可能繼承爸爸的血型。
 
當(dāng)母兒血型不合時(shí)，就有可能發(fā)生溶血。這是因?yàn)樘涸谀赣H體內(nèi)依靠母親供應(yīng)營(yíng)養(yǎng)，但是母親和胎兒之間有一道“胎盤屏障”，這道屏障可以保護(hù)母嬰血液不會(huì)“相互來(lái)往”，不過(guò)仍有少量的嬰兒紅細(xì)胞會(huì)因?yàn)榻q毛的破損而滲入母體循環(huán)。如果母親體內(nèi)的胎兒與母親的血型不同，母親的身體就相當(dāng)于被致敏，啟動(dòng)免疫系統(tǒng)，產(chǎn)生排斥嬰兒血型的抗體，此抗體可通過(guò)胎盤進(jìn)入胎兒體內(nèi)，結(jié)合在嬰兒紅細(xì)胞的表面，導(dǎo)致溶血，嬰兒就會(huì)發(fā)生溶血病。
 
如：O型血的媽媽懷了由父親方遺傳而來(lái)的A型血的胎兒，由于O型血媽媽體內(nèi)沒(méi)有A抗原，當(dāng)A型胎兒紅細(xì)胞進(jìn)入媽媽體內(nèi)時(shí)，媽媽體內(nèi)會(huì)產(chǎn)生抗A抗體，抗A抗體進(jìn)入寶寶體內(nèi)就會(huì)引起寶寶的紅細(xì)胞破壞而溶血。
 

abo溶血嚴(yán)重嗎？

abo溶血嚴(yán)重嗎？其實(shí)abo溶血的癥狀可輕可重，大部分情況下的abo溶血都是不嚴(yán)重，可以自我調(diào)節(jié)改善的，但部分癥狀會(huì)較為嚴(yán)重，除了會(huì)發(fā)生常見(jiàn)的溶血性貧血外，還可能會(huì)危及生命，所以一定要先檢查清楚寶寶abo溶血的病情哦。
 
并不是所有O型血媽媽所生的寶寶都會(huì)發(fā)生溶血病，而是有的寶寶會(huì)發(fā)病，有的寶寶不發(fā)?。挥械陌Y狀輕，有的癥狀重。這與母親抗體的量多少，抗體與胎兒紅細(xì)胞的結(jié)合程度，抗原的強(qiáng)度及胎兒代償性造血能力有關(guān)。
 
新生兒溶血病既然是夫妻血型不合造成的，那么是否每個(gè)人都要跟血型相同的人結(jié)婚呢？答案顯然是否定的。夫妻血型不合現(xiàn)象很普遍，所以新生兒溶血病也很常見(jiàn)，該病癥狀有輕有重，嬰兒常于生后24小時(shí)以內(nèi)或第二天出現(xiàn)黃疸，并迅速加重，但因?yàn)閶雰后w內(nèi)來(lái)自母親的抗體每天在消耗，所以癥狀會(huì)逐漸好轉(zhuǎn)。該病一般都能及時(shí)發(fā)現(xiàn)，依病情需要通過(guò)光照、藥物、補(bǔ)充鐵劑或輸血治療，幾乎都能治愈，不會(huì)對(duì)孩子未來(lái)的健康造成影響。
 
夫妻雙方有上述血型的情況，可以通過(guò)孕前和孕期檢查并及時(shí)干預(yù)減少新生兒溶血病的發(fā)生。如在孕前被查出血型抗體效價(jià)高者可在孕前先進(jìn)行中藥治療來(lái)降低抗體，預(yù)防懷孕后寶寶患ABO溶血病。
 
即使孕前沒(méi)有做過(guò)抗體檢測(cè)，也可以通過(guò)定期查孕后抗體效價(jià)來(lái)預(yù)防，第一次孕16周開(kāi)始查抗體，第二次孕28～30周，以后2～4周查一次，自抗體效價(jià)增高時(shí)開(kāi)始給予孕婦口服中藥，每日一劑至分娩。這種方法不會(huì)對(duì)胎兒造成傷害，同時(shí)又會(huì)有效降低母體抗體的產(chǎn)生，避免重度溶血的產(chǎn)生。
 

abo溶血治療有后遺癥嗎？

abo溶血治療之后會(huì)不會(huì)留下后遺癥呢？這個(gè)問(wèn)題可要區(qū)分來(lái)看了，一般情況下得看癥狀的輕重，如果病情太過(guò)嚴(yán)重，治療后是會(huì)有后遺癥的，所以我們要及時(shí)發(fā)現(xiàn)，及時(shí)治療，同時(shí)做好孕前檢查，做好預(yù)防措施。
 
Abo溶血的癥狀有輕有重，嬰兒常在出生后24小時(shí)以內(nèi)或第二天出現(xiàn)黃疸，并迅速加重，但因?yàn)閶雰后w內(nèi)來(lái)自母親的抗體每天在消耗，所以癥狀會(huì)逐漸好轉(zhuǎn)。該病一般都能及時(shí)發(fā)現(xiàn)，依病情需要通過(guò)光照、藥物、補(bǔ)充鐵劑或輸血治療，幾乎都能治愈，不會(huì)對(duì)孩子未來(lái)的健康造成影響。
 
ABO溶血癥只要及時(shí)發(fā)現(xiàn)，及時(shí)治療，是完全可以治痊愈的，不會(huì)有后遺癥。如果已經(jīng)有核黃疸，治愈后仍然有后遺癥。嚴(yán)重的ABO溶血病最重的并發(fā)癥是膽紅素腦病，就是普通人說(shuō)的黃疸上腦了。
 
膽紅素腦病的后遺癥是手徐動(dòng)、牙齒發(fā)育不良、眼運(yùn)動(dòng)障礙、聽(tīng)覺(jué)障礙、智力落后、腦癱。當(dāng)然這說(shuō)的是最嚴(yán)重的后遺癥。普通的ABO溶血，經(jīng)過(guò)積極治療后大多數(shù)是不留有后遺癥的。
 

abo溶血如何預(yù)防？

那么，為了避免今后abo溶血癥的發(fā)生及病情的加重，我們現(xiàn)在就來(lái)看看有什么方法可以預(yù)防abo溶血吧。
 
1、如果母親過(guò)去有不明原因的流產(chǎn)、早產(chǎn)、死胎，或上一胎有新生兒重癥黃疸，或確診為新生兒溶血病者，應(yīng)警惕本次妊娠有母子血型不合可能，尤其是血型為O型的準(zhǔn)媽媽，要做好產(chǎn)前檢查。
 
2、如果母親為“O”型或Rh陰性血，應(yīng)在懷孕28、32、36周分別到醫(yī)院檢查抗體和抗體濃度，如果抗體為陽(yáng)性，抗體濃度高則小兒發(fā)生溶血病的可能性極大，可給母親服用退黃中藥，生產(chǎn)前1～2周加服苯巴比妥可減輕新生兒黃疸。
 
3、Rh陰性婦女在娩出Rh陽(yáng)性嬰兒72小時(shí)內(nèi)，肌注抗RhDIgG300μg，下次妊娠29周時(shí)再肌注300μg，效果更好。Rh陰性婦女有流產(chǎn)史者、產(chǎn)前出血、羊膜穿刺后或?qū)m外孕輸過(guò)Rh陽(yáng)性血時(shí)，應(yīng)肌注同樣劑量。
 
4、發(fā)生新生兒溶血病，特別是Rh溶血可能性極大的產(chǎn)婦，如果腹圍過(guò)度增大，體重增加超過(guò)正常，在懷孕35周以后應(yīng)到醫(yī)院檢查羊水，如果羊水中膽紅素濃度含量較高，其他檢查說(shuō)明胎兒肺臟發(fā)育成熟時(shí)，可在35～38時(shí)引產(chǎn)，存活率較高。

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