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目的:探讨导致新生儿胆红素脑病的危险因素,优化其关键性预防措施。方法:回顾性分析1998年1月~2007年12月4 683例新生儿高间接胆红素血症(HB)及其中64例并发胆红素脑病(BE)的临床资料。结果:①4 683例HB患儿中的甲组2 366例为该院分娩,接受胆红素动态监测,HB得到及时治疗,无BE发生;乙组2 317例为市、县、乡镇分娩,没有动态监测胆红素并及时治疗HB,并发64例BE。甲乙两组病因分布对比,差异无统计学意义(P>0.05);②乙组2 317例中,1 187例接受过围产期保健服务者,并发16例BE,1 130例未接受服务者,并发48例BE,对比检验,差异有统计学意义(P<0.01);③导致64例BE的危险因素为:一是围产期母儿因素、溶血因素,感染因素等多病因并存,二是存在缺氧、酸中毒、低体温、低蛋白、低血糖、低热量等合并症。结论:建立健全对HB发生、发展的动态监测机制,针对病因,及早治疗HB,防治合并症,是预防或消除BE的关键措施;加强围产期保健服务,也能有效地降低BE发生率。
Objective: To explore the risk factors of neonatal bilirubin encephalopathy and optimize its key preventive measures. Methods: The clinical data of 4 683 neonates with indirect hyperbilirubinemia (HB) and 64 with complicated bilirubin encephalopathy (BE) were retrospectively analyzed from January 1998 to December 2007. Results: (2) A total of 2 366 cases of Group A were enrolled in this study. A total of 2 366 cases of A group were delivered to this hospital. Bilirubin was monitored dynamically and HB was treated in a timely manner. There were 2 317 cases in Group B with childbirth in cities, counties and towns, Dynamic monitoring of bilirubin and timely treatment of HB, 64 cases of BE. There were no significant differences in the distribution of etiology between the two groups (P> 0.05); ② Among the 2 317 cases of group B, 187 cases received perinatal health care services and 16 cases were complicated with 1130 cases of unacceptable services 48 cases of BE, contrast test, the difference was statistically significant (P <0.01); ③ lead to 64 cases of BE risk factors: First, perinatal maternal and child factors, factors such as hemolysis, infection and coexistence of multiple causes, Is the existence of hypoxia, acidosis, hypothermia, low protein, hypoglycemia, low calorie and other complications. Conclusion: Establishing and perfecting dynamic monitoring mechanism for the occurrence and development of HBeAg, treating etiology, treating HB early and preventing and treating comorbidities are the key measures to prevent or eliminate BE. Strengthening perinatal health care can also effectively reduce the incidence of BE.