新生儿高胆红素血症66例临床分析:新生儿高胆红素血症
[摘要] 目的 探讨本地区新生儿高胆红素血症的病因，为预防及治疗提供依据。 方法 将66例高胆红素血症患儿分为换血组（33例）与未换血组（33例）进行病因分析，并对两组患儿的临床特点进行比较。 结果 两组高胆红素血症的病因均以溶血性因素为首，占62.1%（41例），感染因素占22.7%（15例），原因不明占15.1%（10例）。两组患儿在总胆红素浓度、发现黄染时间、就诊时间和黄疸持续时间等方面进行比较，差异有统计学意义（P ＜ 0.001）。 结论 溶血与感染是新生儿高胆红素血症的主要原因，总胆红素浓度过高和干预延迟是引起高胆红素血症的高危因素。加强宣传，出院后的随访和及时就诊，是减少胆红素脑病发病的关键。
[关键词] 新生儿；高胆红素血症；病因；临床分析
[中图分类号] R722.17 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0040-02
Clinical analysis of neonatal hyperbilirubinemia in 66 cases
WANG Feng SUN Yan
Department of Pediatrics, the 300 Hospital of Xiaohe District in Guiyang City, Guizhou Province, Guiyang 550009, China
[Abstract] Objective To discuss the pathogenesis of neonatal hyperbilirubinemia in our region, in order to provide basis for prevention and treatment. Methods The pathogenesis of 66 cases of hyperbilirubinemia children who were divided into exchange transfusion group (n = 33) and without exchange transfusion group (n = 33) were analyzed, and the clinical features of the two groups were compared. Results The pathogenesis of hyperbilirubinemia in the two groups were the hemolytic factor, infection factor and reason unknown, which accounted for 62.1% (41 cases), 22.7% (15 cases), 15.1% (10 cases) respectively. The total bilirubin concentration, stained yellow find time, visiting time and jaundice duration time were compared between the two groups, the differences were statistically significant (P < 0.001). Conclusion Hemolysis and infection are the main reasons of neonatal hyperbilirubinemia. The high level of total bilirubin concentration and the intervention delay are the risk factors of hyperbilirubinemia. Strengthening propaganda, post-discharge of follow-up and timely treatment are the key of reducing the incidence of bilirubin encephalopathy.
[Key words] Neonatus; Hyperbilirubinemia; Pathogenesis; Clinical analysis
新生儿黄疸是新生儿期最常见疾病，其胆红素代谢紊乱为多种因素所致，严重者可导致胆红素脑病，故及时寻找原因，早期预防，诊断及治疗尤为重要。本研究收集66例高胆红素血症患儿，分析其病因，为临床高胆红素血症的病因学诊断及治疗提供参考。
1 资料与方法
1.1 一般资料
收集2011年8月～2012年3月本院新生儿科收治的高胆红素血症患儿66例，均为足月儿，日龄在1～15 d，其中，男42例，女24例；体重小于2 500 g 10例，大于2 500 g 56例。将66例患儿分为换血组和未换血组，每组30例。
1.2 诊断、换血标准
新生儿高胆红素血症诊断及换血标准参考《实用新生儿学》新生儿高胆红素血症诊断及换血标准[1]，选择在同时期24 h内血清胆红素≥257 μmol/L，24～48 h内血清胆红素值≥342 μmol/L，48～72 h内血清胆红素值≥428 μmol/L，72 h以上血清胆红素≥428 μmol/L，经外周动静脉同步换血治疗。
1.3 其他检测指标
患儿入院治疗前即抽取静脉血查学行血常规，网织红细胞计数，血清总胆红素，间接胆红素，直接胆红素，C反应蛋白，溶血性筛查。怀疑感染者行血培养。
1.4 统计学处理
采用SPSS 11.0统计软件包。计量资料以均数±标准差 （x±s）表示，两组样本均数比较采用t检验，P ＜ 0.05为差异有统计学意义。