355例新生儿高胆红素血症原发病的调查与分析

蔡燕鸿 郭伟中 曾振华

[摘要]目的 调查新生儿高胆红素血症的原发病并分析其各自的病例特点。方法 选取2017年1～12月我院收治的新生儿高胆红素血症355例，对新生儿高胆红素血症原发病进行调查与统计、分析，并归纳各自的病例特點。结果 新生儿感染在所有新生儿高胆红素血症病例中发病率最高，占41.4%；其余病因还见于母乳性黄疸、G6PD缺乏症、新生儿ABO溶血症、头皮血肿等；病例特点：新生儿感染、新生儿感染+G6PD缺乏症、新生儿感染+新生儿ABO溶血、新生儿感染+头皮血肿：起病早、进展快、程度重；G6PD缺乏症、新生儿ABO溶血：起病早、进展快：头皮血肿：持续时间长，其他组病例特点：持续时间长、程度重。结论 355例新生儿高胆红素血症在临床上原发病以新生儿感染最常见。不同原发病引起的高胆红素血症病例特点各有差异。

[关键词]高胆红素血症；新生儿病理性黄疸；原发病；病例特点

[中图分类号] R722.1 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0108-04

[Abstract]Objective To investigate the prevalence of primary diseases leading to neonatal hyperbilirubinemia and analyze the characteristics of their respective cases in order to guide clinical observation，identify the cause of the diseases as early as possible，treat the cause，and prevent the disease progression and the occurrence of bilirubin encephalopathy.Methods From January to December 2017，the primary diseases in 355 neonatal hyperbilirubinemia cases hospitalized in Department of Neonatology in our hospital were investigated，analyzed，and summarized their characteristics.Results The incidence of neonatal infection was highest in all cases of neonatal hyperbilirubinemia，accounting for 41.4%.The remaining etiologies were breast milk jaundice，G6PD deficiency，neonatal ABO hemolysis，scalp hematoma，etc.Cases in neonatal infection，neonatal infection+G6PD deficiency，neonatal infection+neonatal ABO hemolysis，and neonatal infection+scalp hematoma were presented with early onset，rapid progression，and severity.For G6PD deficiency and neonatal ABO hemolysis，the cases were featured by early onset and rapid progression.For scalp hematoma，the cases were characterized by long duration.For other groups of cases，they were featured by long duration and severity.Conclusion Among 355 cases of neonatal hyperbilirubinemia，the most common primary disease is neonatal infection in clinic.Differences are presented in the characteristics of hyperbilirubinemia cases caused by various primary diseases.

[Key words]Hyperbilirubinemia；Neonatal pathologic jaundice；Primary disease；Case characteristics

新生儿高胆红素血症是基层医院新生儿科的常见病，是新生儿期再次入院的最常见原因，胆红素对大脑细胞有毒性，如果得不到及时、有效的治疗，发展成为重度高胆红素血症可能出现急性胆红素脑病甚至核黄疸遗留严重的神经系统后遗症[1]。据统计，世界上每年至少有481 000例足月儿或近足月儿患重度高胆红素血症，而其中的114 000例死亡，另有至少63 000例幸存儿遗留有不同程度的后遗症[2]。新生儿的胆红素水平随着日龄增长，是一个动态变化的过程，且临床……