ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2018, Vol. 10 ›› Issue (1): 56-58.doi: 10.3969/j.issn.1674-3865.2018.01.016

• 临床研究 • 上一篇    下一篇

早产儿高胆红素血症的影响因素

穆怀鑫,李娟   

  1. 110004 沈阳，中国医科大学附属盛京医院新生儿二病房
  • 出版日期:2018-02-25 发布日期:2018-03-23
  • 通讯作者: 李娟，E-mail:lijuan@si-hospital.org
  • 作者简介:穆怀鑫（1986-），男，主治医师。研究方向：新生儿疾病的诊治

Influencing factors of hyperbilirubinemia in preterm infants

MU Huaixin，LI Juan   

  1. Shengjing Hospital of China Medical University, Shenyang 110004,China
  • Online:2018-02-25 Published:2018-03-23

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摘要：
目的
探讨早产儿高胆红素血症的影响因素。
方法
选取2013年6月至2016年12月于中国医科大学附属盛京医院新生儿科收治的胎龄＜37周、诊断为高胆红素血症经光照等治疗的早产儿237例为研究对象，为观察组。选择同期住院、非高胆红素血症的早产儿142例作为对照组。比较两组母孕期因素、早产儿一般情况及早产儿疾病间的关系。
结果
观察组剖宫分娩率43.5%（103/237）、1 min Apgar评分≤7分22.8%（54/237）、第一次排胎便时间＞24 h者27.4%（65/237），显著高于对照组（25.4%、11.3%、17.6%），差异有统计学意义（P<0.05）；观察组酸中毒18.6%（44/237）、新生儿败血症（早发+晚发）8.4%（20/237）、新生儿溶血病5.9%（14/237）、化脓性脑膜炎2.53%（6/237），显著大于对照组（18.3%、0.7%、1.4%及0.7%），差异有统计学意义（P<0.05）。观察组胎龄（33.8±2.1）周和出生体质量（2 259±515）g，明显小于对照组，差异有统计学意义（P<0.05）；观察组血红蛋白（170±21）g/L，高于对照组（163±22）g/L，差异有统计学意义（P<0.05）。多因素Logistic逐步回归分析显示：1 min Apgar评分≤7分(OR=8.189,P<0.05）、剖宫分娩(OR=2.461,P<0.05）、第一次排胎便时间＞24 h（OR=3.214,P<0.05）、新生儿败血症（早发+晚发）（OR=45.385,P<0.05）、高血红蛋白水平（OR=1.024,P<0.05）为早产儿高胆红素血症的危险因素。
结论
多种围产因素导致早产儿高胆红素血症。提高分娩技术、及早发现、及时胃肠喂养会减少早产儿高胆红素血症的发生。

关键词: 高胆红素血症, 影响因素, 早产儿

Abstract:
Objective
To study the influencing factors of hyperbilirubinemia in preterm infants.
Methods
A total of 237 cases of preterm infants under 37 weeks of gestational age diagnosed with hyperbilirubinemia were selected, who received phototherapy in Shengjing Hospital of China Medical University from June 2013 to Dec. 2016, and they were included as the observation group. A total of 142 preterm infants without hyperbilirubinemia hospitalized during the same period were chosen as the control group. Compare the gestational factors of the mothers，  the general condition of the preterm infants and their relationship with the diseases in preterm infants between the two groups.
Results
The cesarean section rate of observation group was 43.5%（103/237）， the rate of 1 min Apgar score≤7 was 22.8%（54/237）， and the rate of time of first meconium＞24 h was 27.4%（65/237）， all being higher than those of control group（25.4%,11.3% and 17.6%，respectively）， and there was statistical difference（P<0.05）. The incidence rate of acidosis（18.6%，44/237），neonatal sepsis（EOS/LOS）（8.4%,20/237）, neonatal hemolysis disease(5.9%,14/237), and suppurative meningitis(2.53%,6/237) was significantly higher than that of control group(18.3%,0.7%,1.4% and 0.7%, respectively), the difference being statistical(P<0.05). The gestational age of the observation group［(33.8±2.1)weeks］ and the birth weight［(2 259±515)g］ were significantly lower than the control group（P<0.05）. The hemoglobin level［(170±21)g/L］ was higher in the observation group than in control group［(163±22)g/L］(P<0.05). Multi-factor Logistic regression analysis showed that the 1 min Apgar score≤7（OR=8.189，P<0.05）, cesarean section（OR=2.461，P<0.05）， the time of first meconium>24 h（OR=3.214，P<0.05）, neonatal sepsis（EOS/LOS）（OR=45.385，P<0.05）， and high level of hemoglobin（OR=1.024，P<0.05） were the risk factors of hyperbilirubinemia in preterm infants.
Conclusion
Many perinatal factors can lead to hyperbilirubinemia in the preterm infants. It will reduce the incidence of hyperbilirubinemia in preterm infants to improve delivery technique， detect early and give timely gastrointestinal feeding.

Key words: Hyperbilirubinemia, Influencing factors, Preterm infants