脐血胆红素预测新生儿黄疸的意义  

Predictive value of umbilical cord blood bilirubin level for subsequent neonatal jaundice

作　　者：孙革[1] 王瑶玲[2] 梁建凤[3] 杜立中[4] 

机构地区：[1]浙江大学医学院附属妇产科医院新生儿科,杭州310006 [2]浙江大学医学院附属邵逸夫医院妇产科 [3]浙江大学医学院附属儿童医院信息科 [4]新生儿重症监护室

出　　处：《中华儿科杂志》2007年第11期848-852,共5页Chinese Journal of Pediatrics

摘　　要：目的研究脐带血胆红素水平预测足月健康新生儿后续黄疸程度的价值。方法 523例足月健康新生儿,测定脐血胆红素、白蛋白水平,监测每日经皮胆红素值(TCB)。对时龄0～24 hTCB≥18;～48 h TCB≥21;～72 h TCB≥25;>72h≥25者,送检静脉血血清胆红素值(TSB),考虑是否需要光疗。将新生儿按脐血胆红素水平分为<30 μmol/L;≥30 μmol/L;≥36 μmol/L;≥42μmol/L,共4组。比较4组新生儿 TCB≥25、TSB>205 μmol/L、TSB>257 μmol/L 及需要光疗的发生率。对脐血胆红素水平预告新生儿黄疸进行分析。比较黄疸组新生儿和非黄疸组新生儿临床特征。结果脐血胆红素水平升高,各组新生儿 TCB≥25、TSB>205 μmol/L、TSB>257 μmol/L 和需要光疗的发生率增加。脐血胆红素水平用于预测新生儿黄疸发生有统计学意义(P<0.001)。黄疸组新生儿脐血胆红素值显著高于非黄疸组(t=10.96,P<0.001)。而脐血清白蛋白值(t=2.38,P>0.05)、妊娠周数(t=-0.90,P>0.05)、出生体重(t=0.10,P>0.05)比较,两组均无统计学差异。结论脐血胆红素水平用于预测足月健康新生儿后续黄疸的程度是一种有效的方法。Objective To investigate the predictive value of umbilical cord serum （UCS） bilirubin for subsequent jaundice in healthy term newborns. Methods Five hundred and twenty-three healthy term newborns （275 boys, 248 girls） were selected. The cord blood total serum bilirubin concentration and the serum albumin concentration were determined. All the infants were assessed for jaundice daily by measurement of transcutaneous bilirubin （TCB）. When the infant＇s TCB was ≥ 18 within the first 24 h after birth, ≥21 at 48 h, ≥25 at or after 72 h, the venous total serum bilirubin （TSB） was determined and treatment against jaundice was applied as needed. The infants were aligned into four groups according to their UCS bilirubin levels, starting from 〈 30 μmol/L（ group 1 ） ; ≥30 μmol/L（ group 2） ; ≥36 μmol/L（ group 3） ; ≥42 μmol/L（group 4）. The frequency of hyperbilirubinemia and phototherapy （PT） were compared among the four groups. An analysis of UCS bilirubin as a predictor of later development of jaundice was performed. The characteristics of the infants who became jaundiced （jaundiced group） were compared with the normal infants （non-jaundiced group）. Results A clear correlation between UCS bilirubin level and the development of hyperbilirubinemia was found in all populations of the four groups. Only eight of the 194 infants in group 1 showed a TCB index ≥25. TSB values 〉205 μmol/L but 〈257 μmol/L were observed in 2 newborns. None of the infants in this group showed TSB 〉257 μmol/L or needed PT. Thirty-two infants in group 2 showed TCB ≥ 25, 12 infants had TSB 〉205 μmol/L but 〈257 μmol/L, 2 infants had TSB 〉 205 μmol/L and received PT. In group 3, one infant developed hyperbilirubinemia at 48 h after birth and received PT. Thirty-nine infants showed TCB ≥ 25, 16 infants TSB 〉 205 μmol/L but 〈 257 μmol/L, 2 infants had TSB 〉205 μmol/L and also received PT. In group 4, 4 infants showed a range of TSB from 200 to 215 μmol/L at 48 h a

关 键 词：黄疸 新生儿 胎血 胆红素 

分 类 号：R722.1[医药卫生—儿科]