新生儿肾上腺出血临床特征及危险因素分析  

Clinical characteristics and risk factors of neonatal adrenal hemorrhage

作　　者：陈昊 李尹艾 富建华[1] 薛辛东[1] Chen Hao;Li Yin′ai;Fu Jianhua;Xue Xindong(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院儿内科,沈阳110004

出　　处：《国际儿科学杂志》2022年第1期63-67,共5页International Journal of Pediatrics

基　　金：辽宁省科技创新重大专项(2020JH1/10300001)。

摘　　要：目的探讨新生儿肾上腺出血(neonatal adrenal hemorrhage,NAH)的临床特征和危险因素,提高对此疾病的认识和诊治水平。方法采用回顾式巢式病例对照研究设计,收集中国医科大学附属盛京医院新生儿科2011年1月至2021年12月诊断NAH患儿的临床资料并对其进行电话随访。以NAH患儿中表现为新生儿高胆红素血症者作为病例组,采用随机数表法,按1∶2的比例抽取同期经影像学排除NAH的新生儿高胆红素血症患儿作为对照组,对比两组临床资料特点并进行Logistic回归分析,探讨NAH发生的危险因素。结果研究期间内诊断NAH共31例,平均胎龄(37.6±2.2)周,其中男性19例,足月儿25例,巨大儿6例,经顺产娩出30例,高胆红素血症29例,产伤8例,窒息7例,胆红素脑病9例,败血症12例,颅内出血13例,贫血17例,呼吸系统疾病9例,高钾血症5例,低钠血症6例。NAH超声血肿内显示为中低回声8例,混合回声6例,液性絮状回声伴或不伴点状回声17例,彩色多普勒血流显像下均无血流信号。右侧26例,左侧4例,双侧1例。随访共26例,多于1~3个月内复查超声提示血肿吸收,最晚6个月后血肿消失。纳入病例组29例,对照组58例。单因素分析提示入院日龄、出生体重、巨大儿、分娩方式、胆红素脑病、新生儿败血症、腹胀、贫血、窒息、总胆红素、间接胆红素、Hb、CRP比例显著高于对照组,差异有统计学意义(P<0.05)。多因素Logistics回归分析显示巨大儿(OR=7.415,95%CI=1.342~40.956,P=0.022)及窒息(OR=12.075,95%CI=1.293~112.736,P=0.029)是NAH发生的独立危险因素。结论NAH常见于顺产足月儿,缺乏特异性临床表现,不明原因持续性高胆红素血症可能是其首发症状,常伴有贫血及离子紊乱,少数患儿可出现肾上腺功能减低。巨大儿和窒息可能是NAH发生的危险因素。Objective To explore the clinical characteristics and risk factors of neonatal adrenal hemorrhage(NAH),and to improve the understanding,diagnosis and treatment of this disease.Methods In this study,a retrospective nested case-control study was used to collect clinical data of neonates diagnosed with NAH from January 2011 to December 2021 in the Department of Neonatology,Shengjing Hospital of China Medical University,and telephone follow-up were conducted for them.NAH infants with manifestations of neonatal hyperbilirubinemia were selected as the case group,and the random number table method was used to select the neonatal hyperbilirubinemia infants with NAH excluded by imaging in the same period at a ratio of 1:2 as the control group.Characteristics of the clinical data of the two groups were compared and analyzed by Logistic regression to explore the risk factors of NAH.Results During the study period,a total of 31 cases of NAH were diagnosed,with an average gestational age of(37.6±2.2)weeks,including 19 males,25 full-term infants,6 cases with macrosomia,30 cases with natural labor,29 cases with hyperbilirubinemia,8 cases with birth injury,7 cases with asphyxia,9 cases with bilirubin encephalopathy,12 cases with sepsis,13 cases with intracranial hemorrhage,17 cases with anemia,9 cases with respiratory disease,5 cases with hyperkalemia,6 cases with hyponatremia.The results of NAH ultrasonography showed that 8 cases of hematoma had medium and low echoes,6 cases of mixed echoes,and 17 cases of liquid flocculent echoes with or without punctate echoes.Color Doppler flow imaging results showed no blood flow signal.There were 26 cases on the right side,4 cases on the left side,and 1 case on both sides.A total of 26 cases were followed up.Ultrasonography showed that most haematomas were absorbed within 1 to 3 months and disappeared within 6 months.Twenty-nine cases were included in the case group and 58 cases in the control group.Univariate analysis showed that age,birth weight,macrosomia,mode of delivery,bilirubin enc

关 键 词：肾上腺出血 黄疸 超声检查 新生儿 

分 类 号：R722.1[医药卫生—儿科]