新生儿高胆红素血症272例临床分析

Clinical analysis of 272 patients with hyperbrilirubinemia in neonats

目的 探讨新生儿高胆红素症的可能病因和治疗。方法 对 2 72例高胆红素血症患儿 ,经皮测胆红素(TCB)、血总胆红素、间接胆红素、直接胆红素及肝功能 (SGPT +白 /球 )的常规监测。选择性监测ABO溶血三项 (直接抗人球蛋白、游离、释放试验 )及RH溶血三项 (抗E、抗D)三项试验 ;选择性进行血培养、病灶分泌物培养 ;选择性ToRch抗体测试。本组治疗均为综合措施 ,包括光疗、酶诱导剂、茵栀黄、静脉使用血浆和丙种球蛋白 ,并根据病因及黄疸程度选择组合。结果 2 72例新生儿高胆红素症的可能病因中 ,母乳性黄疸 115例 (4 2 .2 %) ,围产因素 67例 (2 4.7%) ,新生儿溶血症 48例 (17.6%) ,新生儿败血症 2 9例 (10 .6%) ,新生儿肝炎综合征 13例 (4 .7%)。治愈 2 0 9例 (76.8%) ,好转5 0例 (18.4%) ,未愈 11例 (4 .0 %) ,死亡 2例 (0 .8%)。结论 对具有高胆红素血症致病因素的新生儿进行早期血清胆红素的监测 。

Objective To investigate the possible causes and treatment of hyperbilirubinemia in neonates. Methods 272 patients were analyzed,transcutaneous bilirubinemia (TCB), total bilirubinemia, direct bilirubinemia, indirect bilirubinemia and liver function (SGPT+A/G)were tested. ABO homolysis (direct antiglobution, free test, dilution test) andRH homolysis (anti-E,anti-D) were underwent selectively. Blood culture,focal secretion culture and anti-ToRch were performed selectively. Results In all possible causes of hyperbilirubinemia in 272 neonates, 115 patients were breast milk jaundice (42.2%), 67 patients were perinatal agent (24.7%), 48 patients were hemolytic disease of newborn (17.6%), 29 patients were septicemia of newborn (10.6%), 13 patients were neonatal hepatitis syndrome (4.7%). All neonate were underwent with comprehensive measures, photoxis,zymoexciter, yinzhihuang, blood plasma and gamma globulin.Different combined treatment was performed according to different cause and degree of jaundice. 209 newborns were cured (76.8%), 50 newborns were improvement(18.4%), 11 newborns were not cured (4.0%), 2 newborns were death (0.8%). Conclusion It is very important for the neonate with hyperbilirubinmia to undergo the test of bilirubinemia and diagnosis at the early time.