新生儿中重度贫血性黄疸误诊分析

Analysis of Misdiagnosis of Neonatal Anaemia Combined with Jaundice

目的探讨早期新生儿贫血性黄疸的误诊原因,为临床提供抢救的措施和机会。方法均为早期新生儿第1胎第1产、有急产、臀位产、巨大儿难产、或<2000g的早产儿,在出生后24～72h内进行性贫血性黄疸加重,实验室检查排除“ABO、RH、MN”血型不合及自身免疫性溶血疾病者,进行头颅CT、腹腔及实质性脏器B超检查。结果头颅CT阳性2例,分别为脑室内大量出血,硬膜下及蛛网膜下出血。B超示腹腔及实质性脏器阳性结果的11例,分别为肝右叶包膜下血肿4例,右叶肝脏胚胎瘤破裂伴腹腔积血1例,左肾包膜下血肿2例,右肾上腺血肿1例。右肾包膜下血肿1例,脾包膜下血肿2例。结论凡早期新生儿贫血伴有黄疸临床症状进行性加重者,头颅CT、腹部B超应列为常规检查,它对患儿的抢救成功将起到决定性意义。

Objective To analyze the causes of misdiagnosis of neonatal anaemia combined with jaundice in order to treat the illness early .Methods All selected neonates were the first embryo and the first birth and consisted of acute birth ,breech birth ,giant embryo and premature delivery <2000g and their symptoms of anaemia and jaundice aggravated gradually in 24~72 hours after birth .ABO or RH or MN incompatibility was eliminated and B-mode ultrasound was done to detect the abdomen and CT for head.Results 2 cases with ventricular hemorrhage was diagnosed by head CT, one of them combined with subdural and subarachnoid hemorrhage. 11cases with anaemia combined with jaundice due to haemorrhage of abdominal organ were found by B-mode ultrasound ,including 4 case with subcapsular hematoma of liver,1 case with rupture of the hemangioma of right liver lobe combined with accumulated blood in the abdomen ,2 case with subcapsular hematoma of left kidney,1 case with hematoma of right adrenal gland,1 case with subcapsular hematoma of right kidney,2 case with subcapsular hematoma of spleen . Conclusion B-mode ultrasound should be taken as a routine test for neonates with anaemia combined with jaundice .That should be crucial to the successful treatment.