冯志英
051530河北省石家庄市赵县人民医院儿科
新生儿病理性黄疸的病因分析及应对措施
冯志英
051530河北省石家庄市赵县人民医院儿科
目的:探讨新生儿病理性黄疸的病因及诊治措施。方法:2012年6月-2014年6月收治新生儿病理性黄疸患者98例,对新生儿病理性黄疸病因和诊治措施进行分析和总结。结果:本组98例患儿因围生期因素所引发的新生儿病理性黄疸31例(31.63%),母乳因素26例(26.53%),感染因素24例(24.49%),溶血12例(12.24%),其他因素5例(5.10%)。以间接胆红素升高为主的病理性黄疸74例,治疗有效率94.59%;以直接胆红素升高为主24例,治疗有效率79.17%;共治愈59例,好转30例,总有效率90.82%。结论:引发新生儿病理性黄疸的病因主要有围生期因素、母乳因素、感染因素、新生儿溶血和其他因素,应在积极治疗原发病的基础上给予针对性及对症支持治疗,同时应加强早期观察,防止发生胆红素脑病。
新生儿病理性黄疸;病因;治疗
新生儿黄疸是儿科常见疾病之一,包括生理性黄疸和病理性黄疸两种类型。生理性黄疸通常对新生儿无严重影响,无须给予特殊处理;病理性黄疸是指胆红素聚集于体内所引起的皮肤及其他器官黄染,其病因较为复杂,可导致细胞功能紊乱、使神经系统出现不可逆损害,引发胆红素脑病,进而出现听觉、视觉损害等后遗症,情况严重时可导致患儿死亡[1]。因此,分析新生儿病理性黄疸的病因,做到早预防、早发现、早诊断和早治疗,对于新生儿病理性黄疸预后具有重要意义[2]。本文回顾性分析我院收治的100例新生儿病理性黄疸患者的临床资料,探讨和总结了新生儿病理性黄疸的病因、治疗及护理措施,现报告如下。
2012年6月-2014年6月收治新生儿病理性黄疸患者98例,男53例,女45例,包括足月儿92例,早产儿6例;日龄1~24 d,平均19 d;出生体重:<1 000 g 1例,1 000~1 500 g 10例,1 500~2 500 g 22例,2 500~4 000 g 53例,>4 000 g 12例;出生后至出现黄疸时间<7 d 88例,≥7 d 10例。
诊断标准[3]:本组患儿均符合以下诊断标准:足月儿血清胆红素>221 μmol/L,黄疸持续时间>2周;早产儿>257 μmol/L,黄疸持续时间>4周。血清结合胆红素>34 μmol/L。
治疗:治疗原发病,针对病因进行对症支持治疗,在给予药物治疗的同时进行光照治疗。采用蓝光疗法治疗间接胆红素异常升高的病理性黄疸患儿,采用波长420~470 nm蓝光将未结合胆红素通过光氧化分解为直接胆红素,随之产生的胆绿素等物质水溶性很好,可随尿液和胆汁排出体外,实现退黄的治疗目的。每天给予8~12 h的间断光疗,治疗时保护好生殖器和双眼,出现青铜症停止光疗。药物治疗时使用苯巴比妥等肝酶诱导剂诱导肝酶活力,促进胆红素代谢;应用丙种球蛋白阻断网状内皮系统Fc受体和致敏红细胞结合,进而有效阻断溶血过程,减少胆红素产生;使用茵栀黄口服液进行退黄保肝治疗。
疗效评价标准:①治愈:皮肤黏膜黄染明显消退,血清胆红素<85 μmol/L;②有效:黄染有所减轻,血清胆红素85~221 μmol/L,未出现其他并发症;③无效:黄染无变化或再次出现,血清胆红素无变化。
本组患儿的病因分析结果:本组因围生期因素所引发的新生儿病理性黄疸有 31例(31.63%);母乳因素 26例(26.53%);感染因素24例(24.49%);溶血12例(12.24%);其他因素5例(5.10%)。
本组患儿的治疗效果:本组患儿共治愈59例,好转30例,总有效率90.82%,见表1。
Analysis the causes of neonatal pathological jaundice and its countermeasures
Feng Zhiying
Department of Pediatrics,the People's Hospital of Zhao County,Shijiazhuang City of Hebei Province 051530
Objective:To investigate the etiology of neonatal pathological jaundice and its diagnosis and treatment measures. Methods:100 cases of neonatal pathological jaundice were selected from June 2012 to June 2014,then we analyzed and summarized their etiology and treatment in patients with pathologic jaundice.Results:Among those 98 cases of neonatal pathological jaundice,there were 31 cases caused by perinatal factors(31.63%),26 cases caused by breast factors(26.53%),24 cases caused by infection factor(24.49%),12 cases caused by hemolysis(12.24%),while 5 cases with other factors(5.10%).There were 74 cases of pathologic jaundice caused by increased indirect bilirubin,and the treatment effective rate was 94.59%;24 cases caused by increased direct bilirubin,and the treatment effective rate was 79.17%.59 cases were cured;30 cases were improved;the total efficiency was 90.82%.Conclusion:The mainly causes of neonatal pathological jaundice including perinatal factors,breast factors,infection factors,hemolytic disease of newborn and other factors.It should be given symptomatic and supportive treatment based on the active treatment of primary disease,and also should be strengthened the early observation at the same time,in order to prevent the occurrence of brain bilirubin encephalopathy.
Pathological jaundice of newborn;Etiology;Treatment
10.3969/j.issn.1007-614x.2015.6.44