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目的对石家庄地区新生儿患胆红素脑病的危险因素进行分析并讨论其预防措施。方法选取2011年2月-2014年5月石家庄地区324例患有高胆红素血症的新生儿,按照患儿是否合并胆红素脑病分为观察组(患有高胆红素血症且并发脑病)共162例,对照组(仅患有高胆红素血症)共162例。分析两组患儿一般临床资料、化验指标,针对单因素分析结果中有显著差异的因素采取多因素Logistic回归分析。跟踪患者疾病转归情况。结果相比于对照组,胆红素脑病患儿在其出生时体重、剖宫产、小于胎龄儿、新生儿溶血病或贫血、24 h内黄疸、感染伴发热、血糖升高、颅脑部血肿、先天性遗传病、代谢性酸中毒以及血胆红素相关指标(直接胆红素峰值、总胆红素峰值、总胆红素与白蛋白比值)等15个指标有统计学差异(P<0.05)。Logistic回归分析结果表明颅脑血肿、总胆红素峰值以及24 h内黄疸是导致高胆红素血症脑病发病的危险因素(P<0.05)。观察组患儿死亡或后遗症发生率为13.2%(轻度)、43.6%(中度)、85.0%(重度),对照组患儿无死亡及后遗症发生,两组差异有统计学意义(P<0.01)。结论颅脑部血肿、总胆红素峰值以及24 h内黄疸是造成患儿高胆红素并发脑病的危险因素,通过早期实施干预、胆红素监测、卫生宣教是有效预防高胆红素并发脑病的重要措施。
Objective To analyze the risk factors of bilirubin encephalopathy in newborns in Shijiazhuang and discuss the preventive measures. Methods A total of 324 newborns with hyperbilirubinemia in Shijiazhuang from February 2011 to May 2014 were divided into two groups according to whether the children had bilirubin encephalopathy (observation group with hyperbilirubinemia Concurrent encephalopathy) a total of 162 cases, control group (only with hyperbilirubinemia) a total of 162 cases. The general clinical data and laboratory indexes of two groups of children were analyzed. Multivariable Logistic regression analysis was used to analyze the significant differences among the single-factor analysis results. Track patient outcomes. Results Compared with the control group, children with bilirubin encephalopathy at birth had no significant differences in body weight, cesarean section, small gestational age, hemolytic disease or anemia in newborns, jaundice within 24 h, fever with infection, elevated blood glucose, Hematoma, congenital genetic disease, metabolic acidosis and related indicators of serum bilirubin (direct bilirubin peak, total bilirubin peak, total bilirubin and albumin ratio) and other 15 indicators were statistically significant ( P <0.05). Logistic regression analysis showed that craniocerebral hemorrhage, total bilirubin, and jaundice within 24 h were the risk factors for the onset of hyperbilirubinemia (P <0.05). The incidence of death or sequelae in the observation group was 13.2% (mild), 43.6% (moderate) and 85.0% (severe) respectively. There was no death and sequelae in the control group, with significant difference between the two groups (P < 0.01). Conclusion The cranial hematoma, total bilirubin and jaundice within 24 h are the risk factors of high bilirubin-induced encephalopathy in children. Early intervention, bilirubin monitoring and hygienic education are effective in preventing the complications of hyperbilirubinemia Important measures of encephalopathy.