足月新生儿早期高间接胆红素血症病因的多因素分析

Is Multivariable Analysis of the Origin of High Indirect Bilirubin Hematic Disease in Early Full-term Newborn

目的:探讨足月新生儿早期发生高间接胆红素血症的危险因素。方法:对2008年6月-2011年6月在该院住院的285例足月新生儿作回顾性分析。生后7d内胆红素水平(按小时龄)达到全国新生儿学组推荐的光疗干预标准的170例高间接胆红素血症为黄疸组,同期该院产科出生未达光疗标准的115例为对照组,分别对两组的出生体重、性别、有否窒息、生产方式等15项潜在的危险因素作单因素分析和非条件Logistic回归分析。结果:黄疸组的窒息率、胎头吸引器助产率、3d内禁食(超过12h)率,G-6-PD缺陷发生率较对照组高,而对照组非第一产率较黄疸组高,Logistic回归分析显示围产期窒息(A3)、G-6-PD缺陷(A9)、产后最初3d禁食(A12)的偏回归系数是正值,而分娩胎次(A13)的偏回归系数是负值,黄疸发生的危险性=-0.37+1.200A3+1.216A9+2.193A12-0.637A13,回归方程的敏感性是66.3%,特异性是80.7%。结论:产后早期的禁食、围产期窒息、G-6-PD缺陷是新生儿早期出现高间接胆红素血症的危险因素,而分娩方式是否与黄疸的发生有关有待进一步分析。而多次分娩可能是保护因素。

Objective： The purpose of this study was to discuss the risk factors of indirect Bilimbinemia in the early development of the full-term newborn infants. Methods： A population of 285 full-term newborn infants to be in the Hospital between June 2008 and June 2011 was retrospective studied. Of which, 170 infants with high indirect bilirubin level （age by the hour）were set to the jaundice group, which level had come up to the phototherapy intervention standard after 7 days of the birth,other 115 infants born in the same maternity department as the control group below the level of that standard in the same term. Totally 15 potential risk factors（birth weight, gender, asphyxia or not, mode of production, etc）was measured in the two groups by univariate analysis and unconditional Logistic regression analysis. Results： The rate of asphyxia, fetal head midwifery,3 days fasting（〉12h） and G-6-PD defects in jaundice group is higher than that in the control group, but the rate of non-first pregnancy is opposite. Logistic regression analysis shows that partial regression coefficient of Perinatal suffoeation（A3 ）,G-6-PD defects（A9 ）and first 3 days fasting after childbirth（A12 ） is positive value, while that of birthrank（A12 ） is negative. Risk of jaundice occurrence=-0. 37 ＋ 1. 200A3 ＋ 1.216A9 ＋ 2. 193A12-0. 637A13 ,with a sensitivity of 66. 3% and a specificity of 80. 7% in the regression equation. Conclusion： Postparttun early fast,Perinatal suffocation and G-6-PD defects are the risk factors which result in high indirect bilirubin hematic disease in the early stage of newborn infants;meanwhile whether delivery mode is associated with jaundice needs further analysis ; while multiple delivery may be protection factor.