新生儿黄疸的早期预测与干预研究

Study of early prediction and intervention on neonatal jaundice

目的 探讨对新生儿黄疸早期预测及综合干预对降低病理性黄疸发生率的效果评价.方法 选择2006年1月～2012年1月武汉市汉南区人民医院产科新生儿200例,随机分为观察组和对照组,每组各100例.观察组实施早期干预措施,对照组实施常规管理,不给予早期干预措施.比较两组出生后1、7、14、28 d的黄疸指数、总胆红素、甲胎蛋白（AFP）、谷丙转氨酶（ALT）值,以及第一次排胎便时间及转黄时间.结果 ①随孕龄的增加,总胆红素、AFP、ALT逐渐降低.不同孕龄新生儿的血清总胆红素水平与脐血AFP成正相关关系,（r=0.562,P＜ 0.01）.②观察组干预1d黄疸指数（6.83±1.09）与对照组（6.97±1.03）比较,差异无统计学意义（P＞0.05）.观察组干预7、14、28 d黄疸指数[（7.19±1.16）、（9.26±2.26）、（9.03±1.90）]均低于对照组[（7.82±1.69）、（13.56±1.84）、（13.88±2.85）],差异有统计学意义（P＜0.05）.③观察组第一次排胎便时间[（5.30±1.74）h]与胎便转黄时间[（28.66±1.31）h]均早于对照组[（18.69±3.20）、（60.23±2.18）h],两组比较差异有统计学意义（P＜0.05）.结论 对新生儿黄疸进行早期预测及综合干预,方法简单易行,能有效地降低新生儿病理性黄疸的发病率,在产科应该普遍推广.

Objective To study the early prediction of neonatal jaundice and comprehensive intervention to reduce the assessment rate of pathologic jaundice effect.Methods 200 normal newborns in People＇s Hospital in Hannan District of Wuhan City from January 2006 to January 2012 were selected and randomly divided into observation group and control group with 100 cases in each group,the experimental group was treated with early intervention,the control group was treated with the routine management without intervention measures.Jaundice index 1,7,14,28 days after the intervention between the two groups were compared,total bilirubin,alpha fetal protein （AFP）,ALT value,and the first row of meconium time and turning yellow time were compared.Results ①The total bilirubin,AFP,ALT value were reduced with the raise of gestation age.The positive correlation relationship was found between total bilirubin and AFP （r =0.562,P 〈 0.01）.②The differences of jaundice index 1 day after the intervention between the two groups [（6.83±1.09）,（6.97±1.03）] were not statistically significant （P 〉 0.05）.The jaundice index 7,14,28 days after the intervention in observation group [（7.19±1.16）,（9.26±2.26）,（9.03±1.90）] were lower than those in control group [（7.82±1.69）,（13.56±1.84）,（13.88±2.85）],the differences were statistically significant （P 〈 0.05）.③The first row of meconium time and turning yellow time in observation group [（5.30±1.74）,（28.66±1.31） h] were shorter than those in control group [（18.69±3.20）,（60.23±2.18） h],the differences were statistically significant （P 〈 0.05）.Conclusion Early prediction and intervention on neonatal jaundice is simple and easy to use,it can effectively reduce the incidence of neonatal pathological jaundice rate,it is worthy of promotion in obstetrics.