新生儿高胆红素血症风险矩阵的建立和作用

发布时间：2018-03-31 00:12

  本文选题：新生儿　切入点：经皮胆红素　出处：《中国现代医学杂志》2017年20期

【摘要】：目的利用新生儿小时胆红素曲线结合临床风险因素评分,建立联合风险量化矩阵模型,预测贵州省新生儿高胆红素血症的发生风险。方法选取该院产科出生的5 250例足月儿和近足月儿,连续记录其出生后168 h的经皮胆红素(TCB)值。将出生后72 h内对应的危险区TCB测定值作为预测指标,建立联合风险量化矩阵。结果使用二次方程对TCB曲线进行二次曲线拟合,结果显示,TCB水平在24~48 h内上升速率最快,而后逐渐降低。单因素分析结果显示,胎龄、分娩方式、胎膜早破及喂养方式与72 h后TCB高危险区有关。多因素结果显示,72 h后TCB高危险区与出生体重、分娩方式、胎膜早破及喂养方式有关联。胎龄为36.01~39.99周的研究对象处于72 h后高危险区的可能性是胎龄≥40.00周研究对象的1.73倍;剖宫产出生的新生儿与顺产比较,处于高危险区的可能性可降低51%;与混合人工喂养相比,人工喂养的研究对象处于高危险区的可能性较大[^OR=2.173(95%CI:1.267,3.683)]。建立联合风险量化矩阵模型,分12个区。通过释然比水平高低,将12个区组分为4个风险水平,用以预测新生儿高胆红素的发生可能性。结论基于联合风险量化矩阵和新生儿小时胆红素百分位数曲线,将新生儿分为4个风险水平,可对新生儿TCB水平变化开展精准随访,有效预防新生儿黄疸的发生。
[Abstract]:Objective to predict the risk of neonatal hyperbilirubinemia in Guizhou province by using neonatal bilirubin curve and clinical risk factor score.Methods the TCBs of 5 250 full-term and proximal term infants born in obstetrics department of our hospital were recorded continuously at 168 hours after birth.A joint risk quantification matrix was established by using the TCB values of the corresponding risk areas within 72 hours after birth as the predictors.Results the quadratic equation was used to fit the TCB curve. The results showed that the level of TCB rose fastest in 24 h and then decreased gradually.Univariate analysis showed that gestational age, delivery mode, premature rupture of membranes and feeding mode were associated with high risk area of TCB 72 h later.The multivariate results showed that the high risk area of TCB was associated with birth weight, delivery mode, premature rupture of membranes and feeding mode after 72 hours.The study subjects whose gestational age was 36.01 ~ 39.99 weeks were 1.73 times more likely to be in high risk area after 72 hours than those with gestational age 鈮，

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