早产儿血清胆红素神经损害高危值及其影响因素的研究  

Research on high-risk-value of serum bilirubin to neurotoxicity in premature infants

作　　者：吕回[1] 罗慧[1] 赵宁[1] 黄晓虹[1] 李薇[2] 

机构地区：[1]广州市儿童医院新生儿科,510120 [2]广东省东莞市太平人民医院儿科,523900

出　　处：《实用医学杂志》2005年第9期906-908,共3页The Journal of Practical Medicine

摘　　要：目的:探讨早产儿血清胆红素增高导致神经系统损害时其血清胆红素临界值,以及影响临界值的高危因素。方法:收集2000年1月至2002年12月在我院新生儿科住院的早产儿高胆红素血症患儿病例共167例,以脑干听觉诱发电位(BAEP)出现异常作为神经损害标志。入院后即检测血清胆红素浓度及脑干听觉诱发电位,当出现皮肤黄疸后每日检测血清胆红素浓度及脑干听觉诱发电位一次,直至脑干听觉诱发电位出现异常,并记录出现异常时对应的血清胆红素值。同时记录各患儿的胎龄、出生体重、血清白蛋白值和血pH值。结果:167例早产儿中引起脑干听觉诱发电位异常时,血清间接胆红素临界值为(177.41±27.23)μmol/L。对于出生胎龄<32周、～34周、～36+6周的患儿,导致脑干听觉诱发电位异常时,血清间接胆红素临界平均值分别为(154.67±28.92)μmol/L、(161.61±16.06)μmol/L和(173.76±19.22)μmol/L。应用二元变量相关分析研究,提示出生胎龄、出生体重、血清白蛋白浓度及血pH值均与血清间接胆红素临界值有相关性,其相关系数分别为0.653、0.698、0.593和0.512,P值均<0.001。结论:对于早产儿导致神经损害的胆红素水平明显低于传统的病理性黄疸水平。在判断影响胆红素对中枢神经细胞毒性的高危因素时,应重视出生体重。Objective To explore the critical value of serum bilirubin impairing center nerve cell,and these factors of influencing critical value of serum bilirubin.Methods One hundred and sixty-seven cases of premature infants suffer from hyperbilirubinemia were admitted in our hospital between Jan.2000 and Dec.2002.With risk of value of serum bilirubin,that brainstem auditor evoked potential (BAEP) was became abnormal,it was the mark of impairment of center nerve cell.The concentration of serum bilirubin was assayed and BAEP was detected,when these infants were admitted.Then the concentration of serum bilirubin was assayed and BAEP was detected once every day until the patient's BAEP was became abnormal,the value of serum bilirubin was recorded,meanwhile,gestation age,birth weight,concentration of serum albumin and pH were recorded.Results For all of 167 premature infants,the critical value of unconjugated serum bilirubin was (177.41±27.23)μmol/L.For these infants who birth gestation age was lower 32 weeks,～34 weeks,～< 37 weeks,the high-risk-value of serum indirect bilirubin to nervous toxicity were (154.67±28.92)μmol/L,(161.61±16.06)μmol/L and (173.76±19.22)μmol/L respectively.The high-risk-value of serum indirect bilirubin to neurotoxicity were distinctive correlation respectively with birth gestation age,birth weight,concentration of serum albumin and blood pH (correlation coefficients were respectively 0.653,0.698,0.593 and 0.512,P< 0.001). Conclusion The high-risk-value of serum indirect bilirubin to neurotoxicity in preterm infants is lower distinctive than that of conventional serum indirect bilirubin,birth gestation age,birth weight,concentration of serum albumin and blood pH affect the he high-risk-value of serum indirect bilirubin to neurotoxicity.

关 键 词：早产儿 神经损害 高危值 影响因素 高胆红素血症 

分 类 号：R722.6[医药卫生—儿科]