早产儿出生第1天的血电解质及肾功能测量值分析

摘要

目的 了解早产儿出生第1天的血清电解质及肾功能测量值,并与同阶段足月儿上述指标进行比较,探讨临床治疗中的注意事项,以期指导临床工作.方法 调查了2008年6月～2011年6月入住笔者医院新生儿病区的267例新生儿的血清电解质及肾功能测量值,其中极低出生体重(VLBW)早产儿99例,低出生体重(LBW)早产儿115例,足月儿53例,上述患儿均排除了少尿.采用的生化测量仪为日本Olympus AU5400全自动生化测量仪.测定的内容包括血清钾、钠、钙、氯、尿素氮(BUN)、肌酐(CREA).结果 VLBW早产儿和LBW早产儿的平均血清钾、血尿素氮及血肌酐测量值高于足月儿组(P＜0.01),平均血清钙测量值低于足月儿组(P＜0.01),两组早产儿高钾血症、低钙血症的发生率均高于足月儿组(P＜0.01).VLBW早产儿组的平均血清钾、血尿素氮及血肌酐测量值与LBW早产儿组无差异(P＞0.05),但VLBW早产儿组的高钾血症的发生率高于LBW早产儿组.VLBW早产儿组平均血清钙测量值低于LBW早产儿组(P＜0.01),且低钙血症的发生率高于LBW早产儿组(P＜0.01).3组平均血清钠、氯测量值差异无显著意义,(P＞0.05).结论 早产儿生后第1天的血钾偏高,同时血清钙偏低,尤其是VLBW早产儿,临床上需要对这一特殊人群出生第1天的血钾、血钙进行动态监测,警惕非少尿型高钾血症和低钙血症的发生.%Objective This paper reported the serum electrolyte and renal function measured values in premature infants born in the first day and compared the measured values with full term infants,discussed clinical considerations in order to guide clinical work.Methods A total of 267 newborn infants admitted to Neonatal Intensive Care Unit from June 2008 to June 2011 were recruited including male 140,female 127,of whom 53 were full-term infants and 214 were preterm infants (99 were very low birth weight infants,115 were low birth weight infants).All neonates were excluded oliguria.Serum potassium,sodium,calcium and chlorine,creatinine and urea-nitrogen were measured using the Olympus AU5400 automatic biochemical analyzer made in Japan.Results Mean serum potassium,blood urea nitrogen and creatinine concentration in VLBW preterm infant group and LBW preterm infant groups were higher than those in the full-term infant group (P ＜ 0.01).The mean serum calcium concentrations were lower than those in full-term infant group (P ＜ 0.01).The incidence of hyperkalemia and hypocalcemia in two preterm infant groups were higher than those in full-term infants group (P ＜0.01).There was no significant difference in average serum potassium,blood urea nitrogen and serum creatinine concentrations between the VLBW preterm infant group and LBW preterm infants group(P ＞ 0.05),but the incidence of hyperkalemia in VLBW preterm infant group was higher than LBW preterm infant group.Mean serum calcium concentration in VLBW preterm infant group was lower than that of the LBW preterm infants group (P ＜ 0.01),and the incidence of hypocalcemia in VLBW preterm infant group was higher than that of LBW preterm infant group (P ＜ 0.01).There was no significant difference in serum sodium and chlorine concentration among the three groups(P ＞ 0.05).Conclusion In the 24 hour after birth,premature infant's serum potassium was higher and serum calcium was lower,especially in VLBW preterm infants.It is necessary to monitoring the concentration of serum potassium and calcium in preterm infants during their first day after birth in order to prevent the occurrence of non-oliguric hyperkalaemia and hypocalcemia.