健康新生儿出生后120h内经皮胆红素水平的研究

摘要

目的绘制健康黄种新生儿出生后120h内经皮胆红素（TCB）水平随时间变化的TCB-时间百分位曲线图，为新生儿黄疸的评价提供依据。方法3118例健康新生儿，根据不同产式、不同胎龄及是否需要光疗分别分为顺产和剖宫产组；足月儿、早产儿和过期产儿组；非光疗组和光疗组。所有新生儿均在出生后12~120h内定时测定TCB数据。并针对不同组别的TCB改变情况作相关分析，同时绘制TCB-时间百分位曲线图。结果（1）TCB-时间百分位曲线图反映了健康黄种新生儿出生后120h内TCB水平的自然演变过程。（2）不同分娩方式对健康新生儿TCB水平的影响无统计学差异（P＞0.05）。（3）足月儿与过期产儿组各个时间点TCB均值均无统计学差异（均P＞0.05）。但早产儿组TCB均值于出生96h后明显大于足月儿及过期产儿组（均P＜0.05）。（4）光疗组TCB增长速率虽明显大于非光疗组（P＜0.05），但在出生后24h内两者百分位曲线也有潜在重叠的部分。结论TCB-时间百分位曲线反映了健康黄种新生儿生后120h内的TCB水平自然演变过程，此变化过程与血清胆红素（TSB）改变相互吻合。接近足月的健康早产儿在出院后应进行TCB定期随访，以预防高胆红素血症的发生。%Objective To develop hour- specific transcutaneous bilirubin (TCB) nomogram for healthy Chinese neonates. Methods TCB levles were measured with BiliCheck bilirubinometer from 12 to 120 postnatal hours in 3118 neonates. The neonates were divided into vaginal and cesarean groups according to delivery mode;term infants, premature infants and post-term infants groups according to gestational age;phototherapy and non- phototherapy groups according to requirement of pho-totherapy. The dynamic changes of TCB levels were analyzed, the TCB percentiles for each time points were calculated and the hour- specific nomogram was developed. Results There was no significant difference in TCB levels between neonates with dif-ferent delivery mode (P>0.05). There was no difference in TCB levels between term infants and postterm infants (P>0.05);but the TCB levels in preterm infants were higher than those in term infants and postterm infants after 96h (P<0.05 ). The increasing rate of TCB in phototherapy group was higher than that in non- phototherapy group (P<0.05), however there was stil substantial overlap of TCB values between two groups within 24 postnatal hours. Conclusion The hour- specific TCB nomogram for TCB levels in healthy Chinese neonates in the first 120 postnatal hours has been developed successfully and the TCB levels is coin-cided with total serum bilirubin(TSB) levels. In order to prevent neonatal hyperbilirubinemia, attention should be paid for TCB lev-els in healthy neonates, especial y in those healthy premature neonates.