足月新生儿高胆红素血症的心电图特点

ECG characteristics in full-tern neonatal hyperbilirubinemia patients

目的了解足月新生儿高胆红素血症的心电图特点。方法采用回顾性分析选取郑州大学第三附属医院符合标准的足月新生儿532例进行回顾性分析,其中选取患有高胆红素血症的足月新生儿261例为高胆红素血症组,选取健康足月新生儿271例为对照组,收集2组新生儿的总胆红素结果及心电图报告,记录心电图指标包括:正常、快速心律失常、缓慢心律失常、窦性心律不齐、左心房室肥大、右房室肥大、ST-T及T波改变等,比较2组不同异常类型心电图结果。将高胆红素血症组患儿分为轻、中、重3组进行亚组分析,比较其严重程度与心电图的异常发生率,并采用Spearman秩相关分析检验高胆红素血症患儿胆红素水平与心电图异常结果的相关性。采用二元Logistic回归分析确立影响新生儿高胆红素血症患儿发生心电图异常的因素。结果新生儿高胆红素血症组与健康对照组比较,心电图的异常发生率差异具有统计学意义(P<0.05),2组不同异常心电图结果比较,高胆红素血症组患儿快速心律失常、ST-T及T波改变发生率高(χ^(2)=24.15,P<0.01;χ^(2)=32.39,P<0.01),差异具有统计学意义(P<0.05)。高胆红素血症严重程度与心电图异常发生率的比较显示,与轻度组比较,中度组的快速心律失常(χ^(2)=20.254,P<0.01)和ST-T及T波改变(χ^(2)=8.063,P=0.005)以及重度组的快速心律失常(χ^(2)=4.438,P=0.035)的差异有统计学意义(P<0.05)。通过Spearman秩相关分析显示高胆红素血症严重程度与快速心律失常和ST-T及T波改变发生率呈正相关(P<0.05)。高胆红素血症患儿的总胆红素[OR=1.033,95%CI(1.022,1.045),P<0.01]和肌酸激酶同工酶含量[OR=1.251,95%CI(1.152,1.358),P<0.01]是影响心电图异常的风险因素(P<0.05)。结论新生儿高胆红素血症患者易发生心电图异常,多表现为快速心律失常、ST-T及T波改变,且高胆红素血症严重程度与快速心律失常、ST-T及T波改变发生率呈正相关,总胆红素及肌酸激酶同工酶水平升高是影响心电图异常的风险因素。

Objective To investigate the electrocardiogram characteristics,in full-term neonates with hyperbilirubinemia.Methods A retrospective analysis was conducted among which 261 cases of full-term neonates with hyperbilirubinemia were selected as the hyperbilirubinemia group,and 271 cases of healthy full-term neonates were selected as the control group.Bilirubin test results and electrocardiogram reports of neonates in the two groups were collected.Normal,tachyarrhythmia,bradyarrhythmia,sinus arrhythmia,left atrioventricular hypertrophy,right atrioventricular hypertrophy,ST-T and T-wave changes were compared between the two groups.Patients in the hyperbilirubinemia group were divided into 3 groups of mild,moderate,and severe for subgroup analysis to compare their severity with the incidence of ECG abnormalities,and Spearman′s rank correlation analysis was used to test the correlation between bilirubin levels and abnormal ECG findings in patients with hyperbilirubinem.Binary Logistic regression analysis was used to determine the risk factors of abnormal ECG in patients with neonatal hyperbilirubinemia.Results Compared with the healthy control group,the incidence of abnormal electrocardiogram was statistically significant(P<0.05).The incidence of tachyarrhythmia,ST-T and T-wave changes in hyperbilirubinemia group was higher than that in hyperbilirubinemia group(χ^(2)=24.15,P<0.01;χ^(2)=32.39,P<0.01),the results were statistically significant(P<0.05).The comparison between the severity of hyperbilirubinemia and the incidence of electrocardiogram abnormalities showed that tachyarrhythmia(χ^(2)=20.254,P=0.000),ST-T and T-wave changes(χ^(2)=8.063,P=0.005)and tachyarrhythmia(χ^(2)=4.438,P=0.035)was statistically significant(P<0.05).Spearman rank correlation analysis showed that the severity of hyperbilirubinemia was positively correlated with tachyarrhythmia and the incidence of ST-T and T-wave changes(P<0.05).Total bilirubin[OR(95%CI):1.033(1.022,1.045),P<0.01]and creatine kinase isoenzyme[OR(95%CI)=1.251(1.152,1.358),P<0.01]were risk factors for abnormal electrocardiogram in neonatal hyperbilirubinemia(P<0.05).Conclusion Neonatal hyperbilirubinemia patients are prone to ECG abnormalities,most of which are manifested as tachyarrhythmia,ST-T and T-wave changes,and the severity of hyperbilirubinemia is positively correlated with the incidence of tachyarrhythmia,ST-T and T-wave changes.Increased levels of total bilirubin and creatine kinase isoenzyme are risk factors for abnormal ECG.